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Minimum Clinically Important Difference in 30-s Sit-to-Stand Test After Pulmonary Rehabilitation in Subjects With COPD
Abstract
Background:
The sit-to-stand (STS) test is a feasible tool for measuring peripheral muscle strength of the lower limbs. There is evidence of increasing use of STS tests in patients with COPD. We sought to evaluate in subjects with COPD the minimum clinically important difference in 30-s STS test after pulmonary rehabilitation.
Methods:
Stable COPD subjects undergoing a 30-s STS test and a 6-min walk test (6MWT) before and after pulmonary rehabilitation were included. Responsiveness to pulmonary rehabilitation was determined by the change in 30-s STS test results (Δ 30-s STS) before and after pulmonary rehabilitation. The minimum clinically important difference was evaluated using an anchor-based method.
Results:
96 subjects with moderate-to-severe COPD were included. At baseline, 30-s STS test results were significantly related to distance covered in a 6MWT (6MWD) (r = 0.65, P < .001), FVC (r = 0.46, P < .001), PaCO2 (r = -0.42, P < .001), FEV1 (r = 0.39, P < .001), and age (r = -0.31, P = .002). After pulmonary rehabilitation, a significant improvement in 30-s STS test results was observed (mean difference +2 repetitions, P < .001). The Δ30-s STS was positively related to Δ6MWD (r = 0.62, P < .001), transitional dyspnea index (r = 0.67, P < .001), and baseline residual volume (r = 0.27, P = .007). The receiver operating characteristic curves method identified a Δ 30-s STS cut-off of 2 repetitions as the best discriminating value (area under the curve: 0.892, P < .001) to identify the minimum clinically important difference for Δ6MWD (30 m). In a multivariate logistic regression model, baseline 30-s STS (odds ratio 2.63; 95% CI 1.09-6.35, P = .031) and diffusing capacity of the lung for carbon monoxide (< 53% predicted) (odds ratio 2.49, 95% CI 1.04-5.98, P = .041) predict the risk to have a Δ 30-s STS ≥ 2 repetitions.
Conclusions:
Our study indicates that in stable subjects with moderate-to-severe COPD, the 30-s STS test was a sensitive tool to assess the efficacy of pulmonary rehabilitation. A Δ 30-s STS of ≥ 2 repetitions represented the minimum clinically important difference, which may be predicted by the baseline ability in the 30-s STS test and lung function in terms of diffusing lung capacity (ClinicalTrials.gov registration NCT03627624).
... The CS-30 score (median, first to third quarters) before the intervention was 14 (range, [10][11][12][13][14][15][16][17] in the robot-assisted group and also 14 (range, [11][12][13][14][15][16][17] in the conventional therapy group. The total MoCA-J scores before the intervention were 22 (range, [20][21][22][23][24] in the robotassisted group and 23 (range, [21][22][23][24][25][26] in the conventional therapy group. ...
... The CS-30 score (median, first to third quarters) before the intervention was 14 (range, [10][11][12][13][14][15][16][17] in the robot-assisted group and also 14 (range, [11][12][13][14][15][16][17] in the conventional therapy group. The total MoCA-J scores before the intervention were 22 (range, [20][21][22][23][24] in the robotassisted group and 23 (range, [21][22][23][24][25][26] in the conventional therapy group. ...
... The CS-30 score (median, first to third quarters) before the intervention was 14 (range, [10][11][12][13][14][15][16][17] in the robot-assisted group and also 14 (range, [11][12][13][14][15][16][17] in the conventional therapy group. The total MoCA-J scores before the intervention were 22 (range, 20-24) in the robot-assisted group and 23 (range, [21][22][23][24][25][26] in the conventional therapy group. ...
Background/Objectives: Population aging is rapidly increasing, and the importance of preventive medicine has been stressed. Health checkups, diet, and exercise are of paramount importance. This study aimed to evaluate the effectiveness of a personalized dual-task intervention that combined exercise with cognitive tasks in improving physical and cognitive functions among independently living older individuals. Methods: Participants aged >65 years who were mostly independent in their activities of daily living were divided into two groups. The group receiving the 20 min robot-assisted session was compared with the group receiving traditional functional restoration training. This randomized trial assessed the impact of this intervention on the 30 s chair stand test score and Montreal Cognitive Assessment—Japanese version score of the participants. Results: Both scores significantly improved in the intervention group, indicating enhanced lower-limb function and cognitive capabilities. Conclusions: These findings suggest that integrating cognitive tasks with physical exercise can stand as an effective strategy to improve overall well-being in older people, offering valuable insights for designing comprehensive preventive health programs tailored to this demographic.
... How well 11 Adherence to the rehabilitation programme was logged by the rehabilitation specialist leading the session manually. ...
... Physical fitness was assessed using the 30-s sit-to-stand test (11). The 30-s sit-to-stand test involves recording the number of stands a person can complete in 30 s. Higher scores indicate a greater fitness level. ...
... The MCID for each outcome was obtained from the research literature, as follows: D-12 score (2.83 points) (15), WHO-5 score (10 points) (16), EQ-5D-5L utility (0.05 points) (17), EQ-5D VAS (7 points) (17), sit-to-stand score (2 points) (11). To the authors' knowledge a MCID is not established for DASI score; consequently, a threshold of 5 points was used based on this representing a significant difference in score between patients who did versus did not suffer 1-year new disability or death after non-cardiac surgery (18). ...
Introduction
Two million people in the UK are experiencing long COVID (LC), which necessitates effective and scalable interventions to manage this condition. This study provides the first results from a scalable rehabilitation programme for participants presenting with LC.
Methods
601 adult participants with symptoms of LC completed the Nuffield Health COVID-19 Rehabilitation Programme between February 2021 and March 2022 and provided written informed consent for the inclusion of outcomes data in external publications. The 12-week programme included three exercise sessions per week consisting of aerobic and strength-based exercises, and stability and mobility activities. The first 6 weeks of the programme were conducted remotely, whereas the second 6 weeks incorporated face-to-face rehabilitation sessions in a community setting. A weekly telephone call with a rehabilitation specialist was also provided to support queries and advise on exercise selection, symptom management and emotional wellbeing.
Results
The 12-week rehabilitation programme significantly improved Dyspnea-12 (D-12), Duke Activity Status Index (DASI), World Health Orginaisation-5 (WHO-5) and EQ-5D-5L utility scores (all p < 0.001), with the 95% confidence intervals (CI) for the improvement in each of these outcomes exceeding the minimum clinically important difference (MCID) for each measure (mean change [CI]: D-12: −3.4 [−3.9, −2.9]; DASI: 9.2 [8.2, 10.1]; WHO-5: 20.3 [18.6, 22.0]; EQ-5D-5L utility: 0.11 [0.10, 0.13]). Significant improvements exceeding the MCID were also observed for sit-to-stand test results (4.1 [3.5, 4.6]). On completion of the rehabilitation programme, participants also reported significantly fewer GP consultations (p < 0.001), sick days (p = 0.003) and outpatient visits (p = 0.007) during the previous 3 months compared with baseline.
Discussion
The blended and community design of this rehabilitation model makes it scalable and meets the urgent need for an effective intervention to support patients experiencing LC. This rehabilitation model is well placed to support the NHS (and other healthcare systems worldwide) in its aim of controlling the impacts of COVID-19 and delivering on its long-term plan.
Clinical trial registration
https://www.isrctn.com/ISRCTN14707226, identifier 14707226.
... and validity (Boissy et al., 1999) of maximal grip strength in chronic stroke, good reliability and validity of the 30-STS in community-dwelling older adults (Jones et al., 1999), good reliability (Eng et al., 2004) and validity (Flansbjer et al., 2005) of the 6MWT in chronic stroke, good reliability and validity of the SF-BBS in individuals with acute stroke (Chou et al., 2006), good reliability of the SF-BBS in chronic stroke (Liaw et al., 2012), and good reliability of the standard BBS in Parkinson's disease (Steffen & Seney, 2008). Available reports of minimal clinically important differences (MCIDs) for these assessments in clinical populations also provide benchmarks for identification of meaningful change (see "Data Analysis" section for further information on MCIDs used for each test; Bohannon, 2019;Bohannon & Crouch, 2016;Gervasoni et al., 2017;Zanini et al., 2019). ...
... Descriptive results related to program registration, adherence, and adverse events were summarized. Results of physical fitness and functional assessments were reported individually in the context of prior reports of MCIDs for each of the included tests, as follows: change in grip strength of 5.0 kg based on evidence provided in a systematic review of studies of adults with various health conditions, including stroke (Bohannon, 2019); change in 30-STS of two repetitions considering work conducted in individuals with chronic obstructive pulmonary disease (Zanini et al., 2019); 6MWT distance of 14.0 m given findings of a systematic review spanning various pathologies in adults (Bohannon & Crouch, 2016); and change in SF-BBS of two points given findings in people with MS using the full BBS (Gervasoni et al., 2017). The MCIDs used were not necessarily optimal for each test and participant but were chosen based on the varied neurological conditions and comorbidities experienced by participants in the current work and limited documentation of MCIDs for certain tests and populations. ...
A mixed-methods approach was used to study an individually-tailored community exercise program for people with a range of chronic neurological conditions (e.g., stroke, spinal cord injury, brain injury, multiple sclerosis, Parkinson’s disease) and abilities. The program was delivered to older adults (mean age: 62 ± 9 years) with chronic neurological conditions across a 12-week and an 8-week term. Participants attended 88% of sessions and completed 89% of prescribed exercises in those sessions. There were no adverse events. Clinically important improvements were achieved by all evaluated participants ( n = 8) in at least one testing domain (grip strength, lower-extremity strength, aerobic endurance, and balance). Interviews with participants identified key program elements as support through supervision, social connection, individualized programming, and experiential learning. Findings provide insight into elements that enable a community exercise program to meet the needs of a complex and varied group. Further study will support positive long-term outcomes for people aging with neurological conditions.
... The distance walked in 6 min was recorded in meters. 30 s-STST was performed according to the common protocol described in detail for COPD patients [15]. A standard chair with a seating height of 46 cm was used for testing. ...
... Among them, COPD is the most common condition in which STSTs are utilized [8]. We detected a "moderate" relationship between 30 s-STST and 6MWT in patients with AF with a correlation coefficient of 0.58, which is similar to those reported in patients with COPD (0.65) [15] and pulmonary hypertension (0.66) [10]. Additionally, 30 s-STST and 6MWT yielded similar AUCs for discriminating the symptomatology of the patients. ...
Background:
Since symptomatology is a major predictor of quality of life and an endpoint for the management of atrial fibrillation (AF), practical approaches for objectively interpreting symptom burden and functional impairment are needed.
Aims:
We aimed to provide cut-off values for two frequently used field tests to be able to objectively interpret symptom burden in atrial fibrillation.
Methods:
One hundred twenty-five patients with AF were evaluated with European Heart Rhythm Association (EHRA) score, 6-min walk test (6MWT), 30 s sit-to-stand test (30 s-STST), Short-Form 36 (SF-36), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and spirometry. Patients with EHRA 1 were classified as "asymptomatic", and those with EHRA 2-4 as "symptomatic". Cut-off values of 6MWT and 30 s-STST for discriminating between these patients were calculated.
Results:
The optimal cut-off value was "450 m" for 6MWT (sensitivity: 0.71; specificity of 0.79) and "11 repetitions" for 30 s-STST (sensitivity 0.77; specificity of 0.70). Area under ROC curve was 0.75 for both tests (p < 0.001). Discriminative properties of the two tests were similar, and they were significantly correlated (r = 0.58; p < 0.001). Subgroup analysis revealed patients below cut-off values also had worse outcomes in SF-36, IPAQ-SF, and spirometry.
Conclusions:
In patients with AF, walking < 450 m in 6MWT or performing < 11 repetitions in 30 s-STST indicates increased symptom burden, as well as impaired exercise capacity, quality of life, physical activity participation, and pulmonary function. These cut-off values may help identifying patients who may require adjustments in their routine treatment or who may benefit from additional rehabilitative approaches.
... [34]. Improvements in 30s-STS for both groups (+ 2.5-reps; +3.4-reps) were also within the MCID of 2-3 repetitions [35,36]. ...
... Furthermore, whilst the e cacy of interventions is commonly quanti ed using statistical measures, the use of minimal clinically important difference (MCID) values has been proposed as a key evaluator of translational research [38]. Despite differences in responsiveness to exercise according to baseline function, improvements in 6MWD and 30s-STS were both statistically and clinically signi cant for the two groups, with average improvements exceeding MCIDs for these measures [34][35][36]. Overall, the program was e cacious for the cohort in addressing the marked treatment related reductions in exercise capacity, strength and balance, which subsequently negatively affect QoL and interfere with daily function [5,8]. ...
Purpose: Exercise is an effective adjuvant therapy to address many of the symptoms experienced by Hematopoietic Stem Cell Transplant (HSCT) recipients. However, there is little translational research examining meaningful clinical effects. A retrospective analysis of a community-embedded exercise program based at a large urban comprehensive cancer hospital was conducted, with the aim of establishing the translational value of exercise in a clinical setting. A secondary aim was to determine the impact of baseline function on exercise response.
Methods: The Living Well Program is an evidence-based program supervised by Accredited Exercise Physiologists, delivered through the Chris O’Brien Lifehouse. HSCT recipients are prescribed individualised, once-weekly 1-hour aerobic, resistance and balance training. Changes in physical function (6-minute walk distance, strength, and balance), fatigue, and quality of life measures from baseline to post-intervention were analysed, and also assessed in relation to session attendance. Participants were then stratified as low- or high-function for each measure of physical function.
Results: Data from 48 participants (male n=27, age=54.3±11.7-years) was included in the analysis. Significant improvements were found for all outcome measures, with improvements exceeding minimal clinically important differences for 6-minute walk distance (6MWD) and 30-second sit-to-stand. Greater session attendance correlated with improvements in 6MWD and strength outcomes. Exercise response was greater among those with lower baseline scores for 6MWD only (p<0.001).
Conclusions: An existing exercise program embedded in cancer care was successful in eliciting improvements that are both significant and clinically relevant. Further investigations into key factors that influence the efficacy of these programs are required.
... At least 70% of participants will meet or exceed the minimum clinically important difference or minimal detectable change for the Five Time Sit Stand Test (FTSST), 24 25 Canadian Occupational Performance Measure (COPM), [26][27][28][29] and modified Timed Up and Go (mTUG). [30][31][32] Participants will improve by at least 15% (postulated to be clinically meaningful) on the One Leg Stance Test (OLST), 30 33 34 Pediatric Reach Test (PRT) 30 35 and 30 Second Sit to Stand test (30STS) [36][37][38] from initial assessment to reassessment. ...
Introduction
Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) with alternating treatments, using a new home therapy exercise application, Bootle Boot Camp (BBCamp), offered with and without movement tracking feedback. This study will explore the impact of feedback on engagement, movement quality, lower limb function and family experiences to help understand how technology-supported HEPs should be translated and the added value, if any, of movement tracking technology.
Methods and analysis
In this explanatory sequential mixed-methods study using a SCED, 16 children with CP (aged 6–12 years, Gross Motor Function Classification System levels I–II) will set lower limb goals and be prescribed an individualised HEP by their physiotherapist to complete using BBCamp on their home television equipped with a three-dimensional camera-computer system. Children will complete four weekly exercise sessions over 6 weeks. Children will be randomised to 1 of 16 alternating treatment schedules where BBCamp will provide or withhold feedback during the first 4 weeks. The version of BBCamp that results in the most therapeutic benefit will be continued for 2 final weeks. Goals will be re-evaluated and families interviewed. The primary outcome is adherence (proportion of prescribed exercise repetitions attempted) as a measure of behavioural engagement. Secondary outcomes are affective and cognitive engagement (smiley face ratings), exercise fidelity, lower limb function, goal achievement and participant experiences. SCED data will be analysed using visual and statistical methods. Quantitative and qualitative data will be integrated using joint displays.
Ethics and dissemination
Ethical approval was obtained from the Research Ethics Boards at Bloorview Research Institute and the University of Toronto. Results will be distributed through peer-reviewed journals and scientific conferences.
Trial registration number
NCT05998239; pre-results.
... The 30-CS is a test commonly used to measure the functional strength of the lower limbs in older people [64], in which the individual performs the sit-stand-sit movement without using their arms as many times as possible in a chair with a standardized height for 30 seconds [65]. In this variable, our results demonstrated a significant increase in the number of repetitions (p < 0.05), which is in line with previous studies after a period of the MTP [66,67], including clinical relevance for this population [68]. The 8-FUG test is widely used to assess functional capacity [69] through agility and dynamic balance in older people [70]. ...
Background: Resuming a physical exercise program after a period of cessation is common in older women. Monitoring the responses during this detraining (DT) and retraining (RT) may allow us to analyze how the body reacts to an increase and a reduction in physical inactivity. Therefore, we conducted a follow-up training, DT, and RT in prehypertensive older women to analyze the response to these periods. Methods: Twenty-three prehypertensive older women (EG; 68.3 ± 2.8 years; 1.61 ± 0.44 m) performed 36 weeks of the multicomponent training program (MTP) followed by twelve weeks of DT plus eight weeks of RT. Fifteen prehypertensive older women (CG; 66.3 ± 3.2 years; 1.59 ± 0.37 m) maintained their normal routine. Functional capacity (FC), lipid, and hemodynamic profile were assessed before, during 24 and 36 weeks of the MTP, after 4 and 12 weeks of DT, and after 8 weeks of RT. Results: After 24 weeks of the MTP, only SBP did not improve. Four weeks of DT did not affect lower body strength (30-CS), TC, or GL. Eight weeks of RT improved BP (SBP: −2.52%; ES: 0.36; p < 0.00; DBP: −1.45%; ES: 0.44; p < 0.02), handgrip strength (3.77%; ES: 0.51; p < 0.00), and 30-CS (3.17%; ES: 0.38; p < 0.04) compared with 36 weeks of the MTP. Conclusions: Eight weeks of RT allowed patients to recover the benefits lost with detraining, which after only four weeks affected them negatively, and the systematic practice of exercise contributed to greater regulation of BP since 24 weeks of the MTP proved not to be enough to promote positive effects of SBP.
... The sample size was calculated (OpenEpi software) using the mean difference of maximum oxygen consumption (VO 2max = 4.1 mL.kg -1 .min -1 ), according to previous evidence that performed in-hospital exercise-based CR for VO2 analysis and a standard deviation of experimental and control groups (SD = 2.8 and 3.2, respectively) [20]. From these data, 14 patients (7 per group) were estimated according to a significance level of 5% and statistical power of 80%. ...
The acute myocardial infarction (AMI) present high mortality rate that may be reduced with cardiac rehabilitation. Despite its good establishment in outpatient care, few studies analyzed cardiac rehabilitation during hospitalization. Thus, this study aims to clarify the safety and efficacy of early cardiac rehabilitation after AMI. This will be a clinical, controlled, randomized trial with blind outcome evaluation and a superiority hypothesis. Twenty-four patients with AMI will be divided into two groups (1:1 allocation ratio). The intervention group will receive an individualized exercise-based cardiac rehabilitation protocol during hospitalization and a semi-supervised protocol after hospital discharge; the control group will receive conventional care. The primary outcomes will be the cardiac remodeling assessed by cardiac magnetic resonance imaging, functional capacity assessed by maximal oxygen consumption, and cardiac autonomic balance examined via heart rate variability. Secondary outcomes will include safety and the total exercise dose provided during the protocol. Statistical analysis will consider the intent-to-treat analysis.
Trial registration. Trial registration number : Brazilian Registry of Clinical Trials (ReBEC) ( RBR- 9nyx8hb ).
... The test can also be modified whereby the user can use the armrest of a chair to assist in performing the test with outcomes associated with fall risk. For the 30 s version of the test, the minimum clinically significant difference has been proposed to be 2 repetitions (101). ...
Digital exercise therapies (DET) have the potential to bridge existing care gaps for people living with chronic conditions. Acting as either a standalone, embedded within multi-modal lifestyle therapy, or adjunct to pharmacotherapy or surgery, evidence-based DETs can favorably impact the health of a rapidly growing population. Given the nascent nature of digital therapeutics, the regulatory landscape has yet to mature. As such, in the absence of clear guidelines clinical digital product developers are responsible for ensuring the DET adheres to fundamental principles such as patient risk management and clinical effectiveness. The purpose of this narrative review paper is to discuss key considerations for clinical digital product developers who are striving to build novel digital therapeutic (DTx) solutions and thus contribute towards standardization of product development. We herein draw upon DET as an example, highlighting the need for adherence to existing clinical guidelines, human-centered design and an intervention approach that leverages the Chronic Care Model. Specific topics and recommendations related to the development of innovative and scalable products are discussed which ultimately allow for differentiation from a basic wellness tool and integration to clinical workflows. By embodying a code of ethics, clinical digital product developers can adequately address patients' needs and optimize their own future digital health technology assessments including appropriate evidence of safety and efficacy.
... Our results are in line with studies that analyzed the MTP effect on 30-CS [54,55]. Additionally, we found an increase of approximately two repetitions after an eight-week MTP, which may be considered a significant clinical improvement for this population [56]. For the 8-FUG variable, although our results showed a statistical difference after an eight-week MTP regarding the baseline, the gross decrease in time in seconds was a less than clinically significant improvement (i.e., 3.4-s) [57]. ...
Background:
The multicomponent training program (MTP) is a physical exercise strategy used to combat the sedentary lifestyle in older women (OW). However, periods of interruption in training are common in this population. The aim of our study was to analyze the 8-week MTP effects followed by two, four, and eight weeks of interruption on the lipid profile (LP) and functional capacity (FC) of OW.
Methods:
Twenty-one OW (experimental group [EG], 67.6 ± 3.1 years; 1.55 ± 0.35 m) were subjected to an 8-week MTP followed by a detraining period, and 14 OW (control group [CG], 69.4 ± 4.7 years; 1.61 ± 0.26 m) maintained their daily routine. FC (i.e., 30-s chair stand [30-CS], 8-foot up and go [8-FUG], 6-min walk [6-MWT], handgrip strength [HGS], and heart-rate peak during 6-WMT [HRPeak]), total cholesterol (TC) and triglycerides (TG) were assessed before and after MTP and two, four, and eight weeks after MTP.
Results:
8-week MTP resulted in higher FC and decreased LP values in EG (p < 0.05); two and four weeks of detraining did not promote changes. After eight weeks of detraining TC (ES: 2.74; p = 0.00), TG (ES: 1.93; p = 0.00), HGS (ES: 0.49, p = 0.00), HRPeak (ES: 1.01, p = 0.00), 6-MWT (ES: 0.54, p = 0.04), and 8-FUG (ES: 1.20, p = 0.01) declined significantly.
Conclusions:
Periods of more than four weeks of detraining should be avoided to promote a good quality of life and health in OW. If older people interrupt training for a period longer than four weeks, physical-education professionals must outline specific training strategies to maintain the adaptations acquired with MTP. Future studies should establish these criteria based on ideal training volume, intensity, and frequency.
... Peripheral muscle endurance The peripheral muscle endurance will be evaluated through the 30-s sit-to-stand test (30-STST) [27,28]. The number of ≥ 2 repetitions in the test will be considered for analysis. ...
Background
Evidence has shown that patients with chronic obstructive pulmonary disease present significant deficits in the control of postural balance when compared to healthy subjects. In view of this, it is pertinent to investigate the effects of different therapeutic strategies used alone or in association with pulmonary rehabilitation with the potential to improve postural balance and other outcomes with clinical significance in patients with chronic obstructive pulmonary disease. This study will investigate the effects of an 8-week (short-term) multimodal exercise program [inspiratory muscle training (IMT) plus neuromuscular electrical stimulation (NMES)] on postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program compared to individualized addition of IMT or NMES to pulmonary rehabilitation or standard pulmonary rehabilitation.
Methods
This is a randomized, single-blind, 4-parallel-group trial. Forty patients with chronic obstructive pulmonary disease will be included prospectively to this study during a pulmonary rehabilitation program. Patients will be randomly assigned to one of four groups: multimodal exercise program (IMT + NMES + pulmonary rehabilitation group) or (IMT + pulmonary rehabilitation group) or (NMES + pulmonary rehabilitation group) or standard pulmonary rehabilitation group. Patients will receive two sessions per week for 8 weeks. The primary outcome will be static postural balance and secondary outcomes will include as follows: static and dynamic postural balance, fear of falling, muscle strength and endurance (peripheral and respiratory), functional capacity, health-related quality of life, muscle architecture (quadriceps femoris and diaphragm), and laboratory biomarkers.
Discussion
This randomized clinical trial will investigate the effects of adding of short-term multimodal exercise program, in addition to pulmonary rehabilitation program, in postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation. Furthermore, this randomized control trial will enable important directions regarding the effectiveness of short-term intervention as part of the need to expand the focus of pulmonary rehabilitation to include balance management in chronic obstructive pulmonary disease patients which will be generated.
Trial registration
ClinicalTrials.gov NCT04387318. Registered on May 13, 2020.
... The MCID is defined as "the smallest difference in score which patients perceive as beneficial and which would mandate a change in the patient's management" [7] and is useful because it links the magnitude of change with treatment decisions in clinical practice and emphasises the primacy of the patient's perception [8]. The MCID of relevant outcomes of respiratory muscle training programs has been established, including the maximal inspiratory pressure (MIP) [9,10], inspiratory muscle endurance (IME) [10], and functional exercise tolerance measured by field tests [11][12][13][14] in patients with chronic obstructive pulmonary disease (COPD). Unfortunately, the MCID has not been determined for inspiratory muscle function variables in individuals with long-term post-COVID-19 symptoms. ...
Objective:
To establish the minimal clinically important difference (MCID) for inspiratory muscle strength (MIP) and endurance (IME) in individuals with long-term post-COVID-19 symptoms, as well as to ascertain which of the variables has a greater discriminatory capacity and to compare changes between individuals classified by the MCID.
Design:
Secondary analysis of randomised controlled trial of data from 42 individuals who performed an 8-week intervention of respiratory muscle training programme.
Results:
A change of at least 18 cmH2O and 22.1% of that predicted for MIP and 328.5s for IME represented the MCID. All variables showed acceptable discrimination between individuals who classified as "improved" and those classified as "stable/not improved" (area under the curve ≥0.73). MIP was the variable with the best discriminative ability when expressed as a percentage of prediction (Youden index, 0.67; sensitivity, 76.9%; specificity, 89.7%). Participants classified as "improved" had significantly greater improvements in quality of life and lung function compared with the participants classified as "stable/not improved".
Conclusion:
In individuals with long-term post-COVID-19 symptoms, the inspiratory muscle function variables had an acceptable discriminative ability to assess the efficacy of a respiratory muscle training programme. MIP was the variable with the best discriminative ability, showing better overall performance when expressed as a percentage of prediction.
... This test is a valid tool and is reliable for evaluating the performance of the peripheral muscles of the lower limbs [19]. The participants performed the test, and the evaluator counted the number of repetitions and the minimum clinically significant difference [20]. A higher score indicates a better result on the test. ...
The emergence of COVID-19 has led to serious public health problems. Now that the acute phase of the pandemic has passed, new challenges have arisen in relation to this disease. The post-COVID-19 conditions are a priority for intervention, as months after the onset of the disease, they continue to present symptoms, especially physical and respiratory symptoms. Our aim is to test the efficacy of a fourteen-day telerehabilitation program of respiratory and strength exercises in people with post-COVID-19 conditions. For this purpose, a randomized controlled trial was generated in which data from 48 patients were analyzed using the BS, 30STSTST, MD12, VAFS, and 6MWT tests. The obtained results showed the benefit of the intervention in generating great results with respect to the control group.
... We used GRADE tools to evaluate the quality of evidence for each outcome. Our metaanalysis on muscle strength had a narrow CI, which did not cross the minimal clinically important difference threshold in the chair stand test [46]. It also had direct evidence on yoga intervention among patients with T2DM, and consistent results reflected the absence of heterogeneity. ...
Background:
There is a need for a type of physical activity that could address the challenging cycle of physical inactivity, impaired health-related fitness, and type 2 diabetes mellitus (T2DM) conditions. Yoga could be one type of exercise to overcome the barriers to adhere to regular physical activity. The current study aimed to systematically review the effect of yoga on health-related fitness, including cardiorespiratory fitness, muscle strength, body composition, balance, and flexibility, among patients with T2DM.
Methods:
We systematically searched four databases and two registries (Pubmed, Scopus, Cochrane, Embase, WHO-ITCRP, and Clinicaltrials.gov) in September 2021, following a registered protocol on PROSPERO (CRD42022276225). Study inclusion criteria were T2DM patients with or without complication, yoga intervention as a single component or as a complement compared to other kinds of exercise or an inactive control, health-related fitness, and a randomized, controlled trial or quasi-experimental with control group design. The ROBINS-I tool and ROB 2.0 tool were used to assess the risk of bias in the included studies. A vote-counting analysis and meta-analysis computed using random effects' models were conducted.
Results:
A total of 10 records from 3 quasi-experimental and 7 randomized, controlled trials with 815 participants in total were included. The meta-analysis favored yoga groups compared to inactive controls in improving muscle strength by 3.42 (95% confidence interval 2.42 to 4.43), repetitions of chair stand test, and improving cardiorespiratory fitness by 6.6% (95% confidence interval 0.4 to 12.8) improvement of baseline forced vital capacity. The quality of evidence for both outcomes was low.
Conclusion:
Low-quality evidence favored yoga in improving health-related fitness, particularly muscle strength and cardiorespiratory fitness, among patients with T2DM.
Funding:
All authors in this systematic review received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
... Standing up and sitting down from a chair is one of the daily activities that represents physical independence (Bohannon et al., 2010). A ≥ 2 repetitions number increases have been reported as a minimal clinically important difference in pulmonary patients (Zanini et al., 2019). In our study 3 and 7 more (median) repetitions were performed at 12 and 24 sessions respectively. ...
Objective:
The purpose of this study was to evaluate the effects of a telerehabilitation program for COVID-19 survivors on their functionality, aerobic capacity, upper-lower body strength and skeletal muscle mass index.
Methods:
Fifty patients (22 M); age 54.1±15.4 who became ill with COVID-19 during 2020 completed a 24-session telerehabilitation program. The following measures were taken: Barthel's index, two minutes step test (2MST), elbow flexion one-repetition maximal (1RM), short physical performance battery (SPPB), hand grip strength, 30-second chair stand, skeletal muscle index (SMI), body fat percentage, resting pulse, arterial blood pressure, and pulse oximetry.
Results:
There was a significant increase in the Barthel index (p≤0.0001), 2MST (p≤0.0001), 1RM elbow flexion (p≤0.0001), SPPB (p≤0.0001), hand grip strength (p≤0.0001), 30-second chair stand (p≤0.000l), and SMI (p≤0.0001).
Conclusion:
A 24 session in-home telerehabilitation program promoted the recovery of physical independence and increases in skeletal muscle mass index and physical fitness.
... Standing up and sitting down from a chair is one of the daily activities that represents physical independence (Bohannon et al., 2010). A ≥ 2 repetitions number increases have been reported as a minimal clinically important difference in pulmonary patients (Zanini et al., 2019). In our study 3 and 7 more (median) repetitions were performed at 12 and 24 sessions respectively. ...
Objective: The purpose of this study was to evaluate the effects of a telerehabilitation program for COVID-19 survivors on their functionality, aerobic capacity, upper-lower body strength and skeletal muscle mass index. Methods: Fifty patients (22 M); age 54.1±15.4 who became ill with COVID-19 during 2020 completed a 24-session telerehabilitation program. The following measures were taken: Barthel’s index, two minutes step test (2MST), elbow flexion one-repetition maximal (1RM), short physical performance battery (SPPB), hand grip strength, 30-second chair stand, skeletal muscle index (SMI), body fat percentage, resting pulse, arterial blood pressure, and pulse oximetry. Results: There was a significant increase in the Barthel index (p?0.0001), 2MST (p?0.0001), 1RM elbow flexion (p?0.0001), SPPB (p?0.0001), hand grip strength (p?0.0001), 30-second chair stand (p?0.0001), and SMI (p?0.0001). Conclusion: A 24 session in-home telerehabilitation program promoted the recovery of physical independence and increases in skeletal muscle mass index and physical fitness.
... 22 The patients performed the test, and the evaluator counted the number of repetitions, minimum clinically significant difference. 23 A higher score indicates a better result on that test. The following procedure was performed to standardize the test: Evaluators asked patients to place a straight-backed armless chair with a hard seat, which will be stabilized by placing it against a wall, considering floor to seat height will be between 45 and 50 cm. ...
Objective
To compare the effectiveness of two different exercise-based programs through telerehabilitation in patients with coronavirus disease 2019.
Design
Randomized, controlled, parallel, double-blinded, three-arm clinical trial.
Setting
Patients’ homes through telerehabilitation devices.
Subjects
Subjects with coronavirus disease 2019 in the acute phase.
Interventions
Subjects were divided into three groups: breathing exercises group, strength exercises group or no treatment/control group.
Main measures
We analysed visual analogue scale for fatigue, 6-minute walking test, 30-seconds sit-to-stand test, multidimensional dyspnoea-12 questionnaire and Borg scale at baseline and 14 days later.
Results
From 93 subjects recruited, 88 were enrolled, and 77 patients (mean [SD] age 39.40 [11.71]) completed the 14-days intervention and were included in the analysis: 26 in strength exercises group, 29 in breathing exercises group and 22 in control group. The intergroup analysis shows significant differences between the study groups and control group in all variables ( p < 0.05); Borg scale, multidimensional dyspnoea-12 questionnaire (pre–post intervention score: strength exercises group: 7.85 [6.82] – 4.54[4.82], breathing exercises group: 11.04 [6.49] – 5.32 [3.63], control group: 10.27 [6.49] – 10.59[6.58]), visual analogue scale for fatigue, 6-minute walking test and 30-seconds sit-to-stand test (pre–post intervention score: strength exercises group: 12.19 [4.42] – 13.58 [5.37], breathing exercises group: 11.18 [3.42] – 12.79 [4.00], control group: 10.45 [2.15] – 9.86[1.88]). The greatest effect sizes were found in the variables Borg Scale ( R ² = 0.548) and multidimensional dyspnoea-12 questionnaire ( R ² = 0.475).
Conclusions
Strength exercises group and breathing exercises group obtained significant improvements in fatigue, dyspnoea, perceived effort, and physical state, compared to control group, although the greatest benefits were found for dyspnoea and aerobic capacity in breathing exercises group.
... We used the already validated Spanish version of this test, a valid and reliable instrument to study the multidimensional nature of dyspnoea [22]. • Thirty-Second Sit-To-Stand Test (30STST) [23,24]. This test has been demonstrated to be a valid and reliable tool to assess the peripheral muscle performance of lower limbs. ...
The COVID-19 pandemic has caused distress for healthcare providers due to the respiratory problems it causes, among others. In this situation, rehabilitation of the respiratory system has been suggested and implemented in different COVID-19 patients. This study evaluated the feasibility and effectiveness of a novel program based on breathing exercises through telerehabilitation tools in COVID-19 patients with mild to moderate symptomatology in the acute stage. Forty subjects were randomized in an experimental group, based on pulmonary rehabilitation, and in a control group, of which the subjects did not perform physical activity. Thirty-eight subjects, with nineteen in each group, completed the one-week intervention. We performed measurements using the Six-Minute Walk Test, Multidimensional Dyspnoea-12, Thirty-Second Sit-To-Stand Test, and Borg Scale. Both groups were comparable at baseline. Significant differences were found for all of the outcome measures in favour of the experimental group. Ninety percent adherence was found in our program. A one-week telerehabilitation program based on respiratory exercises is effective, safe, and feasible in COVID-19 patients with mild to moderate symptomatology in the acute stage.
... Thirty seconds sit-to-stand test (30STST) [20,21]. This test has been demonstrated to be a valid and reliable tool to assess peripheral muscle performance of lower limbs. ...
Background and objectives: The COVID-19 pandemic has become a challenge for health systems and, specifically, to physical therapists obligated to adapt their job and stop face-to-face consultations. In this situation, therapeutic exercise has been implemented in different COVID-19 patients. This study evaluated the feasibility and effectiveness of a novel therapeutic exercise program through telerehabilitation tools in COVID-19 patients with mild to moderate symptomatology in the acute stage. Materials and Methods: A total of 40 subjects were randomized an experimental group, based on muscle conditioning, and in a control group, who did not perform physical activity. Thirty-six subjects, 18 in each group, completed the one-week intervention. We measured the six-minute walking test, multidimensional dyspnoea-12, thirty seconds sit-to-stand test, and Borg Scale. Results: Both groups were comparable at baseline. Statistically significant improvement between groups (p < 0.05) in favor of the experimental group was obtained. No differences between gender were found (p > 0.05). Ninety percent adherence was found in our program. Conclusion: A one-week telerehabilitation program based on muscle toning exercise is effective, safe, and feasible in COVID-19 patients with mild to moderate symptomatology in the acute stage.
... It is a valid and reliable measure of quadriceps strength. 21 The MCID has been quoted as ≥2 pre-post PR. 22 The COPD Assessment Tool (CAT) is an 8-item measure quantifying the impact of COPD symptoms on health status. 23 Scores range from 0 to 40 with higher scores indicating a greater impact on health status. ...
Objectives
A transdisciplinary research approach was used to develop a holistic understanding of the physical and psychosocial benefits of dance as an intervention for people living with chronic breathlessness.
Methods
The dance programme was developed in collaboration with British Lung Foundation Breathe Easy members in NE England (Darlington) and London (Haringey). Members of the Darlington group were invited to participate in the programme. An exercise instructor, trained and mentored by a dance facilitator delivered 60–90 min dance classes for 10 consecutive weeks. Exercise capacity, mobility, quadriceps strength, health status, mood and interoceptive awareness were assessed at baseline and after the 10-week programme. Second-to-second heart rate (HR) monitoring was conducted during one of the classes.
Results
Ten individuals were enrolled (n=8 women). Mean (SD) age was 70 (24); Body Mass Index 29.7 (8.1) kg/m ² ; one participant used oxygen and one a walking aid. Seven completed the dance programme. Improvements in all outcome measures were detected, with the exception of the Multidimensional Assessment of Interoceptive Awareness, which individuals found hard to comprehend. Eight participants wore HR monitors during one dance class and spent on average 43.5 (21.8) min with HR corresponding to at least moderate intensity physical activity (≥64% HRmax). People found the dance classes enjoyable and those with relevant past experiences who are optimistic, committed to staying well and playful readily adopted the programme.
Conclusion
A dance programme bringing both physical and psychosocial benefits for people with chronic breathlessness is acceptable when coproduced and evaluated through a transdisciplinary approach.
... Timing began when the subject's back left the backrest and stopped once the back touched the backrest for the fifth time. The minimum clinically important differences for 30s-STST and 5STST have been previously estimated as at least 2 repetitions and 1.7 s, respectively in COPD patients [11,20]. ...
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD classification tool has been used to assess the symptom burden and exacerbation risk of patients with chronic obstructive pulmonary disease (COPD). An area requiring further exploration is the relationship between the GOLD classification's basic components and the measurements acquired by Sit-to-Stand tests (STST). We aimed to study the relationship between STST and the component of the GOLD classification tool. This study was conducted on a sample of 42 COPD subjects with patient history, COPD assessment test (CAT) and spirometry. 5STST performance time and the number 30s-STST repetitions showed differences of statistical significance in COPD subjects considered to be more symptomatic and in subjects with high risk of future exacerbations. Both STSTs correlated significantly with forced expiratory volume in one second % predicted (FEV1%), CAT, number of acute exacerbations in the past year and number of hospitalized exacerbations in the past year. STST performance correlates significantly with items of the CAT questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy. Using multivariate analysis, age, FEV1% and CAT score manifested the strongest negative association with STST performance. 5STST performance time and the number 30s-STST repetitions in COPD patients correlates with the level of symptoms and the risk of future exacerbations that define groups A-D based on GOLD 2018 classification tool (at the time of data acquisition). The correlation of STST performance with CAT score involves specific items of the questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy.
... A standard deviation, 2.5 for within group change scores in the 30 s sit-to-stand performance was identified from pilot data from this study group (2 × case series) following a comparable, concurrent NMES exercise programme 14 . A mean change of 3 repetitions was sought, which is in line with the MCID reported in patients with comparator clinical populations 26,27 . With power set at 80% and alpha at 0.05 (two-tailed), a minimum of N > 12 participants was required for final analysis. ...
The primary aim of this study was to investigate the functional, physiological and subjective responses to NMES exercise in cancer patients. Participants with a cancer diagnosis, currently undergoing treatment, and an had an Eastern Cooperative Oncology Group (ECOG) performance status (ECOG) of 1 and 2 were recommended to participate by their oncologist. Following a 2-week, no-NMES control period, each participant was asked to undertake a concurrent NMES exercise intervention over a 4-week period. Functional muscle strength [30 s sit-to-stand (30STS)], mobility [timed up and go (TUG)], exercise capacity [6-min walk test (6MWT)] and health related quality of life (HR-QoL) were assessed at baseline 1 (BL1), 2-week post control (BL2) and post 4-week NMES exercise intervention (POST). Physiological and subjective responses to LF-NMES were assessed during a 10-stage incremental session, recorded at BL2 and POST. Fourteen participants [mean age: 62 years (10)] completed the intervention. No adverse events were reported. 30STS (+ 2.4 reps, p = .007), and 6MWT (+ 44.3 m, p = .028) significantly improved after the intervention. No changes in TUG or HR-QoL were observed at POST. Concurrent NMES exercise may be an effective exercise intervention for augmenting physical function in participants with cancer and moderate and poor functional status. Implications for cancer survivors: By allowing participants to achieve therapeutic levels of exercise, concurrent NMES may be an effective supportive intervention in cancer rehabilitation.
Reduced physical function caused by bone destruction, pain, anemia, infections, and weight loss is common in multiple myeloma (MM). Myeloma bone disease challenges physical exercise. Knowledge on the effects and safety of physical exercise in newly diagnosed patients with MM is limited. In a randomized, controlled trial, we studied the effect of a 10‐week individualized physical exercise program on physical function, physical activity, lean body mass (LBM), bone mineral density (BMD), quality of life (QoL), and pain in patients newly diagnosed with MM. Lytic bone disease was assessed, and exercise was adjusted accordingly. Primary outcome: knee extension strength. Secondary outcomes: Six‐Minute‐Walk‐Test, 30‐s Sit‐to‐Stand‐Test (SST), grip strength, level of physical activity, LBM, BMD, QoL, and pain. Measurements were conducted pre‐ and post‐intervention, and after 6 and 12 months. We included 100 patients, 86 were evaluable; 44 in the intervention group (IG) and 42 in the control group (CG). No statistically significant differences between groups were observed. Knee extension strength declined in the IG ( p = .02). SST, aerobic capacity, and global QoL improved in both groups. Pain decreased consistently in the IG regardless of pain outcome. No significant safety concerns of physical exercise in newly diagnosed patients with MM were observed.
This study evaluated the feasibility and safety of a telehealth delivered home exercise plus plant-based protein diet in adults with non-alcoholic fatty liver disease (NAFLD). Secondary aims were to assess changes in macronutrient intake, weight, physical activity and physical function. This was a 12-week, randomised controlled feasibility trial including 28 adults aged >45 years with NAFLD randomised to a home muscle strengthening program (3 days/week) with increased protein intake (target ∼1.2-1.5 g/kg/day) from predominately plant-based sources and behavioural change support (3-4 text messages/week) (Pro-Ex n=14) or usual care (UC, n=14). Feasibility was assessed via retention (≤10% attrition), adherence (exercise ≥66%; recommended daily protein serves ≥80%) and safety (adverse events). Secondary outcomes included macronutrient intake (3x24-hour records), weight, moderate-to-vigorous physical activity (MVPA), and 30-second sit-to-stand (STS) performance. Study retention was 89%. Mean exercise adherence (Pro-Ex) was 52% with one adverse event from 241 sessions. In Pro-Ex, mean daily plant protein serves increased (0.9-1.4/day) and animal protein decreased (1.5-1.2/day) after 12-weeks, but overall adherence to the recommended serves/day was 32% (plant) and 42% (animal). Relative to UC, Pro-Ex experienced a mean 2.7 (95%CI: 0.9,4.4) increase in 30-sec STS number, 46-minute (95%CI: -153, 245) increase in MVPA, 1.7kg (95%CI: -3.5, 0.2) decrease in weight, 35.2g (95%CI: 11.0, 59.3) increase in protein. A telehealth, home muscle strengthening and plant-based dietary protein intervention in adults with NAFLD was safe and did improve habitual plant and animal protein intake, but overall adherence was relatively modest suggesting more intensive healthcare support may be required.
Background
The Exercise Right for Active Ageing (ERAA) program was established to improve access to exercise classes for community-dwelling older Australians. The aims of this study were to determine whether older adults, who participated in ERAA exercise classes experienced a change in physical function, and identify factors associated with this change.
Methods
Participants included community-dwelling older adults, aged ≥ 65 years, from every state and territory of Australia. The ERAA program included 12 subsidised, weekly, low- to moderate-intensity exercise classes, delivered by accredited exercise scientists or physiologists (AESs/AEPs). Primary outcomes included the 30 s Sit-to-Stand (STS) and the 3-metre Timed Up and Go (TUG) tests. Secondary outcomes included grip strength, the Chair Sit and Reach test, and waist circumference. Linear mixed-effects regression models were used to evaluate the change in outcomes following program completion, and to determine factors associated with changes in the primary outcomes.
Results
3,582 older adults (77% female) with a median (IQR) age of 72 (69–77) years completed follow-up testing. For all primary and secondary outcomes, there was a statistically significant improvement after program completion (p < 0.001). The STS increased by 2.2 repetitions (95% CI: 2.1, 2.3), the TUG decreased by 0.9 s (95% CI: -1.0, -0.8), right and left grip strength increased by 1.3 kg (95% CI: 1.2, 1.5) and 1.5 kg (95% CI: 1.3, 1.6), respectively, right and left reach increased by 1.7 cm (95% CI: 1.4, 2.0), and waist circumference decreased by 1.2 cm (95% CI: -1.4, -1.1). Greater improvements in STS were observed for participants aged 65–69 years, females, and those with greater socio-economic disadvantage. For the TUG, greater improvements were observed in participants reporting 2 + comorbidities, and residing in outer regional areas and areas with greater socio-economic disadvantage.
Conclusions
Participation of older Australians in the ERAA program, led to statistically significant improvements in physical function. The program reached a large number of older Australians from every state and territory, including those from regional and remote parts of Australia, aged over 85 years, and with high levels of comorbidity, which supports the feasibility and acceptability of AES- and AEP-led exercise classes amongst community-dwelling older Australians.
Trial registration
Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12623000483651). Registered 12 May 2023 - Retrospectively registered, https://www.anzctr.org.au/ACTRN12623000483651.aspx .
Introduction
Although allogeneic hematopoietic stem cell transplantation (HCT) can be a curative therapy for hematologic disorders, it is associated with treatment-related complications and losses in cardiorespiratory fitness and physical function. High-intensity interval training (HIIT) may be a practical way to rapidly improve cardiorespiratory fitness and physical function in the weeks prior to HCT. The primary aim of this study was to assess the feasibility of implementing a pre-HCT home-based HIIT intervention. The secondary aim was to evaluate pre to post changes in cardiorespiratory fitness and physical function following the intervention.
Methods
This was a single-arm pilot study with patients who were scheduled to undergo allogeneic HCT within six months. Patients were instructed to complete three 30-minute home-based HIIT sessions/week between the time of study enrollment and sign-off for HCT. Sessions consisted of a 5-minute warm-up, 10 high and low intervals performed for one minute each, and a 5-minute cool-down. Prescribed target heart rates (HR) for the high- and low-intensity intervals were 80–90% and 50–60% of HR reserve, respectively. Heart rates during HIIT were captured via an Apple Watch and were remotely monitored. Feasibility was assessed via retention, session adherence, and adherence to prescribed interval number and intensities. Paired t-tests were used to compare changes in fitness (VO 2peak ) and physical function [Short Physical Performance Battery (SPPB), 30-second sit to stand, and six-minute walk test (6MWT)] between baseline and sign-off. Pearson correlations were used to determine the relationship between intervention length and changes in cardiorespiratory fitness or functional measures.
Results
Thirteen patients (58.8±11.6 years) participated in the study, and nine (69.2%) recorded their training sessions throughout the study. Median session adherence for those nine participants was 100% (IQR: 87–107). Adherence to intervals was 92% and participants met or exceeded prescribed high-intensity HR on 68.8±34.8% of intervals. VO 2peak improved from baseline to sign-off (14.6±3.1 mL/kg/min to 17.9±3.3 mL/kg/min; p<0.001). 30-second sit to stand and SPPB chair stand scores significantly improved in adherent participants. Improvements in 30-second sit to stand (13.8±1.5 to 18.3±3.3 seconds) and 6MWT (514.4±43.2 to 564.6±19.3) exceeded minimal clinically important improvements established in other chronic disease populations, representing the minimum improvement considered meaningful to patients.
Conclusions
Findings demonstrate that implementing a pre-HCT home-based remotely monitored HIIT program is feasible and may provide benefits to cardiorespiratory fitness and physical function.
Introduction: Tuberculosis (TB) is a lung disease caused by Mycobacterium tuberculosis (MTB), known for its high morbidity and mortality rate. When it infects organs outside the lungs, the condition is called extrapulmonary TB. Case report: A 52-year-old man who came to dr. Cipto Mangunkusumo hospital with worsening abdominal pain since a month ago. During the physical examination, tenderness in the right lower quadrant of the abdomen was felt. Furthermore, blood work showed leukocytosis and thrombocytosis. An X-ray examination revealed loculated pleural effusions. A WSD was placed, and pleural fluid analysis resulted in chylus. Sputum smears were negative. An abdominal CT scan revealed irregular thickening of the caecum wall extending to part of the large intestine and multiple surrounding lymphadenopathies. The patient was diagnosed with gastrointestinal TB and received category 1 anti-TB drugs. Conclusion: The patient also underwent pulmonary rehabilitation and had improvements at the end of the hospitalization period. Keywords: Extrapulmonary TB, Gastrointestinal TB, Loculated empyema, Pulmonary rehabilitation.
Purpose
Cancer survivors physical function response to exercise programs at the group level is well-established. However, to advance toward a more personalized approach in exercise oncology, a greater understanding of individual response is needed. This study utilized data from a well-established cancer-exercise program to evaluate the heterogeneity of physical function response and explore characteristics of participants who did vs. did not achieve a minimal clinically important difference (MCID).
Methods
Physical function measures (grip strength, 6-min walk test (6MWT), and sit-to-stand) were completed pre/post the 3-month program. Change scores for each participant and the proportion achieving the MCID for each physical function measure were calculated. The independent t-tests, Fisher’s exact test, and decision tree analyses were used to explore differences in age, body mass index (BMI), treatment status, exercise session attendance, and baseline value between participants who achieved the MCID vs. those who did not.
Results
Participants (N = 250) were 55 ± 14 years old, majority female (69.2%), white (84.1%), and diagnosed with breast cancer (36.8%). Change in grip strength ranged from − 42.1 to + 47.0 lb, and 14.8% achieved the MCID. Change in 6MWT ranged from − 151 to + 252 m, and 59% achieved the MCID. Change in sit-to-stand ranged from − 13 to + 20 reps, and 63% achieved the MCID. Baseline grip strength, age, BMI, and exercise session attendance were related to achieving MCID.
Conclusions
Findings illustrate wide variability in the magnitude of cancer survivors’ physical function response following an exercise program, and that a variety of factors predict response. Further investigation into the biological, behavioral, physiological, and genetic factors will inform tailoring of exercise interventions and programs to maximize the proportion of cancer survivors who can derive clinically meaningful benefits.
Introduction/Purpose
Exercise interventions among Native American cancer survivors are lacking, despite major cancer health disparities in survivorship. The purpose of this study was to evaluate a 12-wk randomized controlled trial (RCT) of culturally tailored exercise on cancer risk biomarkers and quality of life among Native American cancer survivors and family members.
Methods
Participants were randomized to immediate start versus 6-wk waitlist control at two rural and two urban sites. Participants enrolled in a small feasibility pilot study (only cancer survivors evaluated, n = 18; cohort 1) or larger efficacy pilot study where cancer survivors ( n = 38; cohort 2) and familial supporters ( n = 25; cohort 3) were evaluated concurrently. Resistance, aerobic, flexibility, and balance exercises were tailored by cultural experts representing 10 tribes. Exercises were supervised on-site 1 d·wk ⁻¹ and continued in home-based settings 2–5 d·wk ⁻¹ . Fat mass, blood pressure, hemoglobin A 1c , 6-min walk, sit-to-stand test, and quality of life (Patient-Reported Outcomes Measurement Information System Global Health short form and isolation subscale) were measured. Mixed-effects models evaluated differences between RCT arms from baseline to 6 wk, and 12-wk intervention effects in combined arms.
Results
There were no consistent differences at 6 wk between randomized groups. Upon combining RCT arms, 6-min walk and sit-to-stand tests improved in all three cohorts by 12 wk (both survivors and familial support persons, P < 0.001); social isolation was reduced in all three cohorts ( P ≤ 0.05). Familial support persons additionally improved blood pressure and hemoglobin A 1c ( P ≤ 0.05).
Conclusions
Exercise improved cardiorespiratory fitness and physical function among Native American cancer survivors and familial supporters. A longer intervention may influence other important health outcomes among Native American survivors. Additional improvements demonstrated among Native American family members may have a meaningful impact on cancer prevention in this underserved population with shared heritable and environmental risks.
Introduction
Epidemiological evidence supports an association between higher levels of physical activity and improved cancer survival. Trial evidence is now needed to demonstrate the effect of exercise in a clinical setting. The E xercise during CH emotherapy for O varian cancer (ECHO) trial is a phase III, randomised controlled trial, designed to determine the effect of exercise on progression-free survival and physical well-being for patients receiving first-line chemotherapy for ovarian cancer.
Methods and analysis
Participants (target sample size: n=500) include women with newly diagnosed primary ovarian cancer, scheduled to receive first-line chemotherapy. Consenting participants are randomly allocated (1:1) to either the exercise intervention (plus usual care) or usual care alone, with stratification for recruitment site, age, stage of disease and chemotherapy delivery (neoadjuvant vs adjuvant). The exercise intervention involves individualised exercise prescription with a weekly target of 150 minutes of moderate-intensity, mixed-mode exercise (equivalent to 450 metabolic equivalent minutes per week), delivered for the duration of first-line chemotherapy through weekly telephone sessions with a trial-trained exercise professional. The primary outcomes are progression-free survival and physical well-being. Secondary outcomes include overall survival, physical function, body composition, quality of life, fatigue, sleep, lymphoedema, anxiety, depression, chemotherapy completion rate, chemotherapy-related adverse events, physical activity levels and healthcare usage.
Ethics and dissemination
Ethics approval for the ECHO trial (2019/ETH08923) was granted by the Sydney Local Health District Ethics Review Committee (Royal Prince Alfred Zone) on 21 November 2014. Subsequent approvals were granted for an additional 11 sites across Queensland, New South Wales, Victoria and the Australian Capital Territory. Findings from the ECHO trial are planned to be disseminated via peer-reviewed publications and international exercise and oncology conferences.
Trial registration number
Australian New Zealand Clinical Trial Registry (ANZCTRN12614001311640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367123&isReview=true ).
Background
People with intellectual disabilities (ID) experience high rates of lifestyle related morbidities, in part due to lack of access to tailored health promotion programmes. This study aimed to assess the feasibility and preliminary efficacy of a tailored healthy lifestyle intervention, Get Healthy!
Methods
Get Healthy! is a 12-week physical activity and healthy eating programme designed to address lifestyle-related risks for adults with mild-moderate ID. The feasibility pilot was designed to assess subjective participant experience and programme feasibility across: recruitment and screening, retention, session attendance and engagement, adverse events, and practicality and reliability of outcome procedures. Exploratory programme efficacy was assessed across the following measures: anthropometry (body mass index, weight, waist circumference), cardiovascular fitness, physical strength, dietary intake, healthy literacy, and quality of life.
Results
Six participants with moderate ID and two carer participants completed the feasibility trial, representing a 100% retention rate. Qualitative data indicated the programme was well received. Participants with ID attended 75% of sessions offered and displayed a high level of engagement in sessions attended (91% mean engagement score). While most data collection procedures were feasible to implement, several measures were either not feasible for our participants, or required a higher level of support to implement than was provided in the existing trial protocol. Participants with ID displayed decreases in mean waist circumference between baseline and endpoint (95% CI: − 3.20, − 0.17 cm) and some improvements in measures of cardiovascular fitness and physical strength. No changes in weight, body mass index, or objectively measured knowledge of nutrition and exercise or quality of life were detected from baseline to programme endpoint. Dietary intake results were mixed.
Discussion
The Get Healthy! programme was feasible to implement and well received by participants with moderate ID and their carers. Exploratory efficacy data indicates the programme has potential to positively impact important cardiometabolic risk factors such as waist circumference, cardiovascular fitness, and physical strength. Several of the proposed data collection instruments will require modification or replacement prior to use in a sufficiently powered efficacy trial.
Trial registration
ACTRN: ACTRN12618000349246. Registered March 8th 2018—retrospectively registered, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374497 UTN: U1111-1209–3132.
Abstract Background Symptomatic spinal stenosis is a prevalent complication in adults with achondroplasia. Increased muscle fat infiltration (MFI) and reduced thigh muscle volumes have also been reported, but the pathophysiology is poorly understood. We explored whether the increased MFI and reduced thigh muscle volumes were associated with the presence of symptomatic spinal stenosis and physical functioning. Methods MFI and thigh muscle volumes were assessed by MRI in 40 adults with achondroplasia, and compared to 80 average-statured controls, matched for BMI, gender, and age. In achondroplasia participants, the six-minute walk-test (6MWT), the 30-s sit-to-stand test (30sSTS), and a questionnaire (the IPAQ) assessed physical functioning. Results Symptomatic spinal stenosis was present in 25 of the participants (the stenosis group), while 15 did not have stenosis (the non-stenosis group). In the stenosis group, 84% (21/25) had undergone at least one spinal decompression surgery. The stenosis group had significantly higher MFI than the non-stenosis group, with an age-, gender and BMI-adjusted difference in total MFI of 3.3 percentage points (pp) (95% confidence interval [CI] 0.04 to 6.3 pp; p = 0.03). Compared to matched controls, the mean age-adjusted difference was 3.3 pp (95% CI 1.7 to 4.9 pp; p
Background:
PR during hospitalization for AECOPD occurs during a period of disease instability for the patient, and the safety and efficacy of PR specifically during the hospitalization period has not been established.
Objective:
The purpose of this review is to determine the safety and efficacy of PR during the hospitalization phase for individuals with an AECOPD.
Data sources:
Scientific databases were searched up to August 2022 for randomized controlled trials that compared in-hospital PR with usual care. PR programs commenced during the hospitalization and included a minimum of two sessions.
Data extraction:
Titles and abstracts followed by full-text screening and data extraction were conducted independently by two reviewers. The intervention effect estimates were calculated through meta-analysis using a random-effect model.
Synthesis:
Twenty-seven studies were included (n=1317). The meta-analysis showed that inpatient PR improved the 6 minute walk distance by 105 meters (p<0.001). Inpatient PR improved the performance on the five repetition sit-to-stand test by -7.02 seconds (p=0.03). QOL as measured by the 5Q-5D-5L and the St. George's Respiratory Questionnaire was significantly improved by the intervention. Inpatient PR increased lower limb muscle strength by 33.35N (p<0.001). There was no change in length of stay. Only one serious adverse event related to the intervention was reported.
Conclusion:
This review suggests that it is safe and effective to provide PR during hospitalization for individuals with an AECOPD. In-hospital PR improves functional exercise capacity, QOL, and lower limb strength without prolonging the hospital LOS.
Background
Sit-To-Stand (STS) tests are reported as feasible alternatives for the assessment of functional fitness but the reliability of these tests in people with coronary artery disease (CAD) has not been reported. This study explored the test-retest reliability, convergent and known-groups validity of the five times, 30-sec and 1-min sit-to-stand test (FTSTS test, 30-s STS test and 1-min STS test respectively) in patients with CAD. The feasibility of applying these tests to distinguish the level of risk for cardiovascular events in CAD patients was also investigated.
Methods
Patients with stable CAD performed a 6MWT and 3 STS tests in random order on the same day. Receiver operating characteristic (ROC) curve analyses were conducted using STS test data to differentiate patients with low or high risk of cardiovascular events based on the risk level determined by distance covered in the 6MWT as > or ≤ 419 m. Thirty patients repeated the 3 STS tests on the following day.
Results
112 subjects with diagnoses of atherosclerosis or post-percutaneous coronary intervention, or post-acute myocardial infarction (post-AMI) participated in the validity analysis. All 3 STS tests demonstrated moderate and significant correlation with the 6MWT (coefficient values r for the FTSTS, 30-s STS and 1-min STS tests were−0.53, 0.57 and 0.55 respectively). Correlations between left ventricular ejection fraction (LVEF) and all STS tests and between 6MWT and LVEF were only weak ( r values ranged from 0.27 to 0.31). Subgroup analysis showed participants in the post-AMI group performed worse in all tests compared to non-myocardial infarction (non-MI) group. The area under the curve (AUC) was 0.80 for FTSTS (sensitivity: 75.0%, specificity: 73.8%, optimal cut-off: >11.7 sec), and the AUC, sensitivity, specificity and optimal cut-off for 30-s STS and 1-min STS test were 0.83, 75.0%, 76.2%, ≤ 12 repetitions and 0.80, 71.4%, 73.8%, ≤ 23 repetitions respectively. The intraclass correlation coefficients (ICC) for repeated measurements of the FTSTS, 30-s STS and 1-min STS tests were 0.96, 0.95 and 0.96 respectively, with the minimal detectable change (MDC 95 ) computed to be 1.1 sec 1.8 repetitions and 3.9 repetitions respectively.
Conclusions
All STS tests demonstrated good test-retest reliability, convergent and known-groups validity. STS tests may discriminate low from high levels of risk for a cardiovascular event in patients with CAD.
Objective
We compared the effects of resistance exercise (REx) and resistance exercise combined with neuromuscular electrical stimulation (NMES+REx) on muscle strength, functional lower extremity strength, and mobility in hematological cancer patients during chemotherapy.
Methods
Forty-three adult patients were recruited and randomized into the REx group versus personalized and progressive NMES+REx. The lower extremity muscle strength (digital hand dynamometer) test and functional and mobility tests [30-s sit-to-stand test, Timed Up and Go test (TUG)] were performed pre-and postintervention.
Results
The Eastern Cooperative Oncology Group-Performance Score (ECOG-PS) of 90% of all patients was ≥2. Increases in steroid dose after transplantation were associated with decreases in hip flexion and knee extension muscle strength values (respectively; rs:-0.468, p:0.008; rs:-0.527, p: 0.002). There was a significant improvement in strength measurement, functional and mobility tests, and ECOG-PS in both groups (p<0.05). It revealed significant main effect of treatment (F(1,28): 33.527; p<0.001; n2p: 0.545) and interaction effect with group (F(1,28): 5.909; p<0.022; n2p: 0.174) but not with the steroid dose (F(1,28): 0.523; p<0.475; n2p: 0.018). In addition to that there is no between-subject effects (F(1,28): 0.066; p<0.799; n2p: 0.002). The NMES+REx group had significantly higher knee extension values than the REx group (p=0.036).
Conclusion
REx training given to hematological cancer patients receiving intensive chemotherapy after hematopoietic stem cell transplantation improved muscle weakness. The combination of NMES training with resistance exercises resulted in significant results comparable to REx training alone in adult hematological patients with moderate-low ECOG-PS.
Objectives
To perform a systematic review with meta-analysis to verify the effects of multicomponent and resistance training on the physical performance in older adult residents in long-term care, as well as to compare these modalities.
Design
Systematic review with meta-analysis of randomized controlled trials.
Setting and Participants
Older adults age over 60 years who are nursing home residents in long-term care.
Methods
Seven electronic databases (PubMed, Embase, Central, Web of Science, SportDiscus, LILACS, and SCIELO) were searched from their inception until May 1, 2022. The methodological quality was assessed using PEDro scale. Mean difference and 95% confidence interval were pooled using a random-effects model. The significance level established was P value of ≤.05 for all analyses.
Results
A total of 30 studies were included in the qualitative review (n = 1887, mean age 82.68 years and 70% female). Multicomponent training appeared in 19 studies and resistance training in 12 studies. Out of these, 17 studies were incorporated into the meta-analysis. Multicomponent training and resistance training showed statistically significant difference (P ≤ .05) in the physical performance of institutionalized older adults compared with the control groups (usual care); this was evaluated with the Short Physical Performance Battery (+1.2 points; +2 points), 30-second chair-stand (approximately +3 repetitions; both), and Timed Up and Go (−4 seconds on mean; both) tests. Comparisons between multicomponent and resistance training did not show statistically significant differences in any of the physical outcomes evaluated.
Conclusions and Implications
The studies provide evidence that both multicomponent training and resistance training may be effective in improving the physical performance of institutionalized older adults. Further studies with more representative sample numbers, an improvement in methodological quality, and a more specified prescription of the training used are necessary.
Falls are a major issue in older adults with cancer due to the effects of cancer and its treatments. Ample evidence in the general population of older adults has demonstrated the effectiveness of strength and balance training in reducing fall rates in older adults. However, data on effective fall prevention interventions in the oncology setting are lacking. The objective of this study is to evaluate the feasibility and efficacy of a remotely delivered, partially-supervised, resistance and balance training program on lower body strength, balance, and falls in community-dwelling older adults with cancer. The proposed study is an observer-blinded, parallel group (intervention group vs. control group) randomized controlled trial (ClinicalTrials.gov Identifier: NCT04518098). This study will recruit 74 eligible community-dwelling older adults with cancer from a comprehensive cancer centre. Intervention includes a remotely delivered exercise program for 3 months. Outcome measures include feasibility measures, lower body strength, balance, and fall rates. Research ethics approval has been granted by the Biomedical Research Ethics Boards of the University of Saskatchewan. If found effective, findings from this study will inform a subsequent, phase III definitive trial, with the ultimate goal to reduce falls and reduce impact on cancer treatment. Study findings will be disseminated through presentation at community level and scientific conferences, and in scientific journals.
Trial registration: ClinicalTrials.gov identifier: NCT04518098
Background:
Pulmonary rehabilitation (PR) is an evidence-based, nonpharmacological intervention aimed to improve quality of life for patients living with Chronic Obstructive Pulmonary Disease (COPD). Unfortunately, in Canada, most PR programs are hospital based and these are few in number; therefore, accessibility to PR programs is limited.
Methods:
The Edmonton Southside Primary Care Network implemented an evidence-based PR program within the setting of the patient's medical home.
Results:
Post-program evaluation demonstrated improvement in 6-minute walk distance, lower body strength, COPD health status, and quality of life, as well as a reduction in emergency department visits 1 year after program completion.
Conclusion:
The results conclude that delivery of a PR program in a primary care setting is effective and can help address the issue of accessibility.
Background
: The COVID-19 pandemic is expected to bring a surge of survivors in need of post-acute rehabilitation. Preliminary research and clinical guidelines suggest patients recovering from critical illness associated with COVID-19 will present compromised function similar to acute respiratory distress syndrome (ARDS) and ICU-acquired weakness (ICUAW). However, information regarding physical therapy and progressions of physiological and functional outcomes is currently limited. This case report describes the course of recovery of a patient without significant preexisting medical conditions.
Case Description
: The patient RW (male, age 56) tested positive for COVID-19, and was admitted to ICU for 29 days. After weaning off mechanical ventilation after 2 months of hospitalization, he was transferred to our post-acute rehabilitation facility to recover from the residual effects. Physical therapy evaluation showed that while the patient was cognitively alert, he exhibited impaired general strength and activity intolerance due to severe exertional dyspnea. The patient received physical therapy aimed at improving his functional capacity. During his 16-day stay, the patient was able to significantly improve his capacities (i.e. 600% increase in 30-second chair stand test, 69.5% improvement in walking distance in 6-minute walk test, and 132.4% longer time to exhaustion during level ground ambulation). Dyspnea remained the main factor that limited his activities.
Discussion
: This case demonstrated that post-acute physical therapy appeared to be effective and safe in improving function after critical illness due to COVID-19 for this patient. Physical therapists are encouraged to closely monitor respiratory parameters such as heart rate, oxygen saturation, and levels of dyspnea during treatment for patient response and decisions regarding activity progression.
OBJECTIVE
Minimal clinically important difference (MCID) thresholds for a limited number of outcome metrics were previously defined for patients with failed back surgery syndrome (FBSS) at 6 months after spinal cord stimulation (SCS). This study aimed to further define MCID values for pain and disability outcomes. Additionally, the authors established 1-year MCID values for outcome measures with previously defined metrics commonly used to assess SCS efficacy.
METHODS
Preoperative and 1-year postoperative outcomes were collected from 114 patients who received SCS therapy for FBSS, complex regional pain syndrome, and neuropathic pain. MCID values were established for the numerical rating scale (NRS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), McGill Pain Questionnaire (MPQ), and Pain Catastrophizing Scale (PCS). Four established anchor-based methods were utilized to compute MCID values with two anchored questions: “Are you satisfied with SCS therapy?” and “Would you have SCS surgery again?” For each question, patients were categorized as responders if they answered “yes” or as nonresponders if they responded “no.” The methodologies utilized to compute MCID scores included the average change method, minimum detectable change approach, change difference calculation, and receiver operating characteristic (ROC) analysis. Area under the ROC curve (AUC) analysis has been shown to inform the accuracy at which the MCID value can distinguish responders from nonresponders and was analyzed for each instrument.
RESULTS
For the first time, ranges of MCID values after SCS were established for MPQ (1–2.3) and PCS (1.9–13.6). One-year MCID values were defined for all indications: NRS (range 0.9–2.7), ODI (3.5–6.9), and BDI (2–5.9). AUC values were significant for NRS (0.78, p < 0.001), ODI (0.71, p = 0.003), MPQ (0.74, p < 0.001), and PCS (0.77, p < 0.001), indicating notable accuracy for distinguishing satisfied patients.
CONCLUSIONS
This was the first study to successfully determine MCID values for two prominent instruments, MPQ and PCS, used to assess pain after SCS surgery. Additionally, previously established MCID values for ODI, BDI, and the visual analog scale for patients with FBSS at 6 months after treatment were explored at 12 months for the most common indications for SCS. These data may better inform physicians of patient response to and success with SCS therapy.
Purpose
The aims of this systematic review were to: (1) describe physical activity (PA) levels following diagnosis of primary brain cancer, (2) determine the relationship between PA levels and health outcomes, and (3) assess the effect of participating in an exercise intervention on health outcomes following a diagnosis of brain cancer.
Methods
PubMed, EMBASE, Scopus and CINAHL were searched for relevant articles published prior to May 1, 2020. Studies reporting levels of PA, the relationship between PA and health outcomes, and exercise interventions conducted in adults with brain cancer were eligible. The search strategy included terms relating to primary brain cancer, physical activity, and exercise. Two independent reviewers assessed articles for eligibility and methodological quality (according to Joanna Briggs Institute Critical Appraisal Tools). Descriptive statistics were used to present relevant data and outcomes.
Results
15 studies were eligible for inclusion. Most adults with brain cancer were insufficiently active from diagnosis through to post-treatment. Higher levels of PA were associated with lower severity of brain cancer specific concerns and higher quality of life. Preliminary evidence suggests that exercise is safe, feasible and potentially beneficial to brain cancer symptom severity and interference, aerobic capacity, body composition and PA levels. However, the level of evidence to support these findings is graded as weak.
Conclusions
Evidence suggests that it is likely appropriate to promote those with brain cancer to be as physically active as possible. The need or ability of those with brain cancer to meet current PA guidelines promoted to all people with cancer remains unclear.
Introduction: High levels of physical, cognitive, and psychosocial impairments are anticipated for those recovering from the COVID-19. In the UK, ~50% of survivors will require additional rehabilitation. Despite this, there is currently no evidence-based guideline available in England and Wales that addresses the identification, timing and nature of effective interventions to manage the morbidity associated following COVID-19. It is now timely to accelerate the development and evaluation of a rehabilitation service to support patients and healthcare services. Nuffield Health have responded by configuring a scalable rehabilitation pathway addressing the immediate requirements for those recovering from COVID-19 in the community.
Methods and Analysis: This long-term evaluation will examine the effectiveness of a 12-week community rehabilitation programme for COVID-19 patients who have been discharged following in-patient treatment. Consisting of two distinct 6-week phases; Phase 1 is an entirely remote service, delivered via digital applications. Phase 2 sees the same patients transition into a gym-based setting for supervised group-based rehabilitation. Trained rehabilitation specialists will coach patients across areas such as goal setting, exercise prescription, symptom management and emotional well-being. Outcomes will be collected at 0, 6, and 12 weeks and at 6- and 12-months. Primary outcome measures will assess changes in health-related quality of life (HR-QOL) and COVID-19 symptoms using EuroQol Five Dimension Five Level Version (EQ-5D-5L) and Dyspnea-12, respectively. Secondary outcome measures of the Duke Activity Status Questionnaire (DASI), 30 s sit to stand test, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Patient Experience Questionnaire (PEQ) and Quality Adjusted Life Years (QALY) will allow for the evaluation of outcomes, mediators and moderators of outcome, and cost-effectiveness of treatment.
Discussion: This evaluation will investigate the immediate and long-term impact, as well as the cost effectiveness of a blended rehabilitation programme for COVID-19 survivors. This evaluation will provide a founding contribution to the literature, evaluating one of the first programmes of this type in the UK. The evaluation has international relevance, with the potential to show how a new model of service provision can support health services in the wake of COVID-19.
Trial Registration: Current Trials ISRCTN ISRCTN14707226
Web: http://www.isrctn.com/ISRCTN14707226
Introduction
In the Spring of 2020, New York City was an epicenter of COVID‐19. The post‐hospitalization needs of COVID‐19 patients were not understood and no outpatient rehabilitation programs had been described.
Objective
We implemented a program across two hospital campuses to treat patients discharged home with persistent COVID‐19 symptoms. We evaluated if a virtual rehabilitation program would lead to improvements in strength and cardiopulmonary endurance when compared with no intervention.
Design
Prospective cohort study
Setting
Academic medical center
Patients
We treated 106 patients discharged home with persistent COVID‐19 symptoms between April‐July 2020. 44 patients performed virtual physical therapy (VPT); 25 patients performed home physical therapy (HPT); 17 patients performed independent exercise program (IE); and 20 patients did not perform therapy.
Interventions
All patients were assessed by physiatry. VPT sessions were delivered via secure HIPAA‐compliant telehealth platform 1‐2 times/week. Patients were asked to follow up 2 weeks after initial evaluation.
Main Outcome Measures
Primary study outcome measures were the change in lower body strength, measured by the 30‐second sit‐to‐stand test; and the change in cardiopulmonary endurance, measured by the 2‐minute step test.
Results
At the time of follow up, 65% of patients in the VPT group and 88% of patients in the HPT group met the clinically meaningful difference (CMD) for improvement in sit‐to‐stand scores, compared with 50% and 17% of those in the IE group and no‐exercise group (p=0.056). 74% of patients in the VPT group and 50% of patients in the HPT, IE and no‐exercise groups met the CMD for improvement in the step test (p=0.12).
Conclusions
Virtual outpatient rehabilitation for patients recovering from COVID‐19 improved lower limb strength and cardiopulmonary endurance, while a home physical therapy program improved lower limb strength. Virtual rehabilitation seems to be an efficacious method of treatment delivery for recovering COVID‐19 patients.
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COVID-19 has spread throughout the world causing a significant number of cases of pneumonia and SARS. Patients with COVID-19 may also have other cardiovascular, respiratory, and neuromuscular disorders. These multisystemic complications present the need for comprehensive interventions focused on improving symptoms, functional capacity, and quality of life. Pulmonary rehabilitation has the potential to offer some of these benefits. However, the evidence related to specific aspects of pulmonary rehabilitation evaluation and intervention in COVID19 is limited. We have learned from experiences with other types of chronic lung diseases that have used pulmonary rehabilitation successfully, so that while the own evidence of rehabilitation emerges in COVID-19, it is necessary to establish some initial recommendations, prepared according to the sequelae found until now.
Similar to six-minute walk test (6MWT), sit-to-stand test (STST) is a self-paced test which elicits sub-maximal effort; therefore, it is suggested as an alternative measurement for functional exercise capacity in various pulmonary conditions including COPD and cystic fibrosis. We aimed to investigate the association between 30-second STST (30s-STST) and 6MWT in both children with bronchiectasis (BE) and their healthy counterparts, as well as exploring cardiorespiratory burden and discriminative properties of both tests.
Methods
Sixty children (6 to 18-year-old) diagnosed with non-cystic fibrosis BE and 20 age-matched healthy controls were included. Both groups performed 30s-STST and 6MWT. Test results, and heart rate, SpO 2 and dyspnea responses to tests were recorded.
Results
Univariate analysis revealed that 30s-STST was able to explain 52% of variance in 6MWT ( r = 0.718, p<0.001) in BE group, whereas 20% of variance in healthy controls ( r = 0.453, p = 0.045). 6MWT elicited higher changes in heart rate and dyspnea level compared to 30s-STST, indicating it was more physically demanding. Both 30s-STST (21.65±5.28 vs 26.55±3.56 repetitions) and 6MWT (538±85 vs 596±54 m) were significantly lower in BE group compared to healthy controls ( p<0.01). Receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve (UAC) of 0.765 for 30s-STST and 0.693 for 6MWT in identifying the individuals with or without BE ( p<0.05). Comparison between AUCs of 30s-STST and 6MWT yielded no significant difference ( p = 0.466), indicating both tests had similar discriminative properties.
Conclusions
30s-STST is found to be a valid alternative measurement for functional exercise capacity in children with BE.
Background
Individuals with a diagnosis of cancer tend to be inactive and have symptoms that impact quality of life. An individualized, community-based Nordic pole walking (NPW) program may help.
Methods
Primary Objective : To assess feasibility using the Thabane framework of a randomized controlled trial (RCT). Secondary Objective : To determine the effects of NPW on physical function (Six-Minute Walk Test [6MWT], 30-second [30-s] chair stand test, Unsupported Upper-Limb Exercise Test, handgrip strength, physical activity [PA]), and health-related quality of life (HRQOL, 36-item Short-Form Health Survey [SF-36]). The Study Design : An 8-week multicentered block RCT (no blinding) comparing a community-based NPW program (vs usual daily routine) for adults with non-small cell lung, prostate, colorectal, and endometrial cancer.
Results
Eight individuals were enrolled in the study with n = 4 per group (1 dropout in the NPW arm; = 67 ± 6 years). The study was deemed “feasible with modifications.” NPW significantly improved (statistically and clinically) the 30-s chair stand test when compared with baseline. There was improved 6MWT, PA levels, and SF-36 when compared with the control group (not statistically significant). No adverse events occurred.
Discussion, Limitations, and Conclusions
NPW was feasible for individuals with cancer and may improve physical function, PA, and HRQOL. Larger samples are required to determine efficacy and/or program effectiveness. Future programs should include collaboration with hospital cancer centers and support groups, promotion of participant and community engagement with NPW, and consideration of the population's unique characteristics. NPW programs should include individualized exercise prescriptions, behavior change techniques, social aspects, HRQOL assessments, and device-measured PA.
Background:
Different protocols for the sit-to-stand test (STS) are available for assessing functional capacity in COPD. We sought to correlate each protocol of the STS (ie, the 5-repetition [5-rep STS], the 30-s STS, and the 1-min STS) with clinical outcomes in subjects with COPD. We also aimed to compare the 3 protocols of the STS, to verify their association and agreement, and to verify whether the 3 protocols are able to predict functional exercise capacity and physical activity in daily life (PADL).
Methods:
23 subjects with COPD (11 men; FEV153 ± 15% predicted) performed 3 protocols of the STS. Subjects also underwent the following assessments: incremental shuttle walking test, 6-min walk test (6MWT), 4-m gait speed test (4MGS), 1-repetition maximum of quadriceps muscle, assessment of PADL, and questionnaires on health-related quality of life and functional status.
Results:
The 1-min STS showed significant correlations with the 6MWT (r = 0.40), 4MGS (r = 0.64), and PADL (0.40 ≤ r ≤ 0.52), and the 5-rep STS and 30-s STS were associated with the 4MGS (r = 0.54 and r = 0.52, respectively). The speed differed for each protocol (5-rep STS 0.53 ± 0.16 rep/s, 30-s STS 0.48 ± 0.13 rep/s, 1-min STS 0.45 ± 0.11 rep/s, P = .01). However, they presented good agreement (intraclass correlation coefficient ≥ 0.73 for all) and correlated well with each other (r ≥ 0.68 for all). More marked changes in peripheral oxygen saturation (P = .004), heart rate (P < .001), blood pressure (P < .001), dyspnea (P < .001), and leg fatigue (P < .001) were found after the 1-min STS protocol. Furthermore, the 3 protocols were equally able to identify subjects with low exercise capacity or preserved exercise capacity.
Conclusions:
The 1-min STS generated higher hemodynamic demands and correlated better with clinical outcomes in subjects with COPD. Despite the difference in speed performance and physiological demands between the 5-rep STS and 1-min STS, there was a good level of agreement among the 3 protocols. In addition, all 3 tests were able to identify subjects with low exercise capacity or preserved exercise capacity.
Background
The 1-minute sit-to-stand (STS) test could be valuable to assess the level of exercise tolerance in chronic obstructive pulmonary disease (COPD). There is a need to provide the minimal important difference (MID) of this test in pulmonary rehabilitation (PR).
Methods
COPD patients undergoing the 1-minute STS test before PR were included. The test was performed at baseline and the end of PR, as well as the 6-minute walk test, and the quadriceps maximum voluntary contraction (QMVC). Home and community-based programs were conducted as recommended. Responsiveness to PR was determined by the difference in the 1-minute STS test between baseline and the end of PR. The MID was evaluated using distribution and anchor-based methods.
Results
Forty-eight COPD patients were included. At baseline, the significant predictors of the number of 1-minute STS repetitions were the 6-minute walk distance (6MWD) (r=0.574; P<10⁻³), age (r=−0.453; P=0.001), being on long-term oxygen treatment (r=−0.454; P=0.017), and the QMVC (r=0.424; P=0.031). The multivariate analysis explained 75.8% of the variance of 1-minute STS repetitions. The improvement of the 1-minute STS repetitions at the end of PR was 3.8±4.2 (P<10⁻³). It was mainly correlated with the change in QMVC (r=0.572; P=0.004) and 6MWD (r=0.428; P=0.006). Using the distribution-based analysis, an MID of 1.9 (standard error of measurement method) or 3.1 (standard deviation method) was found. With the 6MWD as anchor, the receiver operating characteristic curve identified the MID for the change in 1-minute STS repetitions at 2.5 (sensibility: 80%, specificity: 60%) with area under curve of 0.716.
Conclusion
The 1-minute STS test is simple and sensitive to measure the efficiency of PR. An improvement of at least three repetitions is consistent with physical benefits after PR.
Background
Individuals with COPD may present reduced peripheral muscle strength, leading to impaired mobility. Comprehensive pulmonary rehabilitation (PR) should include strength training, in particular to lower limbs. Furthermore, simple tools for the assessment of peripheral muscle performance are required.
Objectives
To assess the peripheral muscle performance of COPD patients by the sit-to-stand test (STST), as compared to the one-repetition maximum (1-RM), considered as the gold standard for assessing muscle strength in non-laboratory situations, and to evaluate the responsiveness of STST to a PR program.
Methods
Sixty moderate-to-severe COPD inpatients were randomly included into either the specific strength training group or into the usual PR program group. Patients were assessed on a 30-second STST and 1-minute STST, 1-RM, and 6-minute walking test (6MWT), before and after PR. Bland–Altman plots were used to evaluate the agreement between 1-RM and STST.
Results
The two groups were not different at baseline. In all patients, 1-RM was significantly related to the 30-second STST (r=0.48, P<0.001) and to 1-minute STST (r=0.36, P=0.005). The 30-second STST was better tolerated in terms of the perceived fatigue (P=0.002) and less time consuming (P<0.001) test. In the specific strength training group significant improvements were observed in the 30-second STST (P<0.001), 1-minute STST (P=0.005), 1-RM (P<0.001), and in the 6MWT (P=0.001). In the usual PR program group, significant improvement was observed in the 30-second STST (P=0.042) and in the 6MWT (P=0.001).
Conclusion
Our study shows that in stable moderate-to-severe inpatients with COPD, STST is a valid and reliable tool to assess peripheral muscle performance of lower limbs, and is sensitive to a specific PR program.
Functional activities, such as the sit-to-stand-to-sit (STSTS) task, are often impaired in individuals with chronic obstructive pulmonary disease (COPD). The STSTS task places a high demand on the postural control system, which has been shown to be impaired in individuals with COPD. It remains unknown whether postural control deficits contribute to the decreased STSTS performance in individuals with COPD.
Center of pressure displacement was determined in 18 individuals with COPD and 18 age/gender-matched controls during five consecutive STSTS movements with vision occluded. The total duration, as well as the duration of each sit, sit-to-stand, stand and stand-to-sit phase was recorded.
Individuals with COPD needed significantly more time to perform five consecutive STSTS movements compared to healthy controls (19±6 vs. 13±4 seconds, respectively; p = 0.001). The COPD group exhibited a significantly longer stand phase (p = 0.028) and stand-to-sit phase (p = 0.001) compared to the control group. In contrast, the duration of the sit phase (p = 0.766) and sit-to-stand phase (p = 0.999) was not different between groups.
Compared to healthy individuals, individuals with COPD needed significantly more time to complete those phases of the STSTS task that require the greatest postural control. These findings support the proposition that suboptimal postural control is an important contributor to the decreased STSTS performance in individuals with COPD.
To determine reference values for the 1-min sit-to-stand (STS) test in an adult population.
Cross-sectional study nested within a nationwide health promotion campaign in Switzerland. Adults performed the STS test and completed questions on demographics and health behavior.
6,926 out of 7,753 (89.3 %) adults were able to complete the STS test. The median number of repetitions ranged from 50/min (25-75th percentile 41-57/min) in young men and 47/min (39-55/min) in young women aged 20-24 years to 30/min (25-37/min) in older men and 27/min (22-30/min) in older women aged 75-79 years.
The reference values support the interpretation of 1-min STS test performance and identification of subjects with decreased lower body muscular strength and endurance.
Exercise tests are important to characterise chronic obstructive pulmonary disease patients and predict their prognosis, but are often not available outside of rehabilitation or research settings. Our aim was to assess the predictive performance of the sit-to-stand and handgrip strength tests.
The prospective cohort study in Dutch and Swiss primary care settings included a broad spectrum of patients (n=409) with Global Initiative for Chronic Obstructive Lung Disease stages II to IV. To assess the association of the tests with outcomes, we used Cox proportional hazards (mortality), negative binomial (centrally adjudicated exacerbations) and mixed linear regression models (longitudinal health-related quality of life) while adjusting for age, sex and severity of disease.
The sit-to-stand test was strongly (adjusted hazard ratio per five more repetitions of 0.58, 95% CI 0.40–0.85; p=0.004) and the handgrip strength test moderately strongly (0.84, 95% CI 0.72–1.00; p=0.04) associated with mortality. Both tests were also significantly associated with health-related quality of life but not with exacerbations. The sit-to-stand test alone was a stronger predictor of 2-year mortality (area under curve 0.78) than body mass index (0.52), forced expiratory volume in 1 s (0.61), dyspnoea (0.63) and handgrip strength (0.62).
The sit-to-stand test may close an important gap in the evaluation of exercise capacity and prognosis of chronic obstructive pulmonary disease patients across practice settings.
Rationale:
Outcomes other than spirometry are required to assess nonbronchodilator therapies for chronic obstructive pulmonary disease. Estimates of the minimal clinically important difference for the 6-minute-walk distance (6MWD) have been derived from narrow cohorts using nonblinded intervention.
Objectives:
To determine minimum clinically important difference for change in 6MWD over 1 year as a function of mortality and first hospitalization in an observational cohort of patients with COPD.
Methods:
Data from the ECLIPSE cohort were used (n = 2,112). Death or first hospitalization were index events; we measured change in 6MWD in the 12-month period before the event and related change in 6MWD to lung function and St. George's Respiratory Questionnaire (health status).
Measurement and main results:
Of subjects with change in the 6MWD data, 94 died, and 323 were hospitalized. 6MWD fell by 29.7 m (SD, 82.9 m) more among those who died than among survivors (P < 0.001). A reduction in distance of more than 30 m conferred a hazard ratio of 1.93 (95% confidence interval, 1.29-2.90; P = 0.001) for death. No significant difference was observed for first hospitalization. Weak relationships only were observed with change in lung function or health status.
Conclusions:
A reduction in the 6MWD of 30 m or more is associated with increased risk of death but not hospitalization due to exacerbation in patients with chronic obstructive pulmonary disease and represents a clinically significant minimally important difference.
High-level activities are typically not performed by patients with chronic obstructive pulmonary disease (COPD), which results in reduced functional performance; however, the physiological parameters that contribute to this reduced performance are unknown. The aim of this study was to determine the relationships between high-level functional performance, leg muscle strength/power, aerobic power, and anaerobic power. Thirteen patients with COPD underwent an incremental maximal cardiopulmonary exercise test, quadriceps isokinetic dynamometry (isometric peak torque and rate of torque development; concentric isokinetic peak torque at 90°/sec, 180°/sec, and 270°/sec; and eccentric peak torque at 90°/sec), a steep ramp anaerobic test (SRAT) (increments of 25 watts every 10 seconds), and three functional measures (timed up and go [TUG], timed stair climb power [SCPT], and 30-second sit-to-stand test [STS]). TUG time correlated strongly (P < 0.05) with all muscle strength variables and with the SRAT. Isometric peak torque was the strongest determinant of TUG time (r = -0.92). SCPT and STS each correlated with all muscle strength variables except concentric at 270°/sec and with the SRAT. The SRAT was the strongest determinant of SCPT (r = 0.91), and eccentric peak torque at 90°/sec was most significantly associated with STS (r = 0.81). Performance on the SRAT (anaerobic power); slower-velocity concentric, eccentric, and isometric contractions; and rate of torque development are reflected in all functional tests, whereas cardiopulmonary exercise test performance (aerobic power) was not associated with any of the functional or muscle tests. High-level functional performance in patients with COPD is associated with physiological parameters that require high levels of muscle force and anaerobic work rates.
Exacerbations of chronic obstructive pulmonary disease (COPD) acutely reduce skeletal muscle strength and result in long-term loss of functional capacity.
To investigate whether resistance training is feasible and safe and can prevent deteriorating muscle function during exacerbations of COPD.
Forty patients (FEV(1) 49 +/- 17% predicted) hospitalized with a severe COPD exacerbation were randomized to receive usual care or an additional resistance training program during the hospital admission. Patients were followed up for 1 month after discharge. Primary outcomes were quadriceps force and systemic inflammation. A muscle biopsy was taken in a subgroup of patients to assess anabolic and catabolic pathways.
Resistance training did not yield higher systemic inflammation as indicated by C-reactive protein levels and could be completed uneventfully. Enhanced quadriceps force was seen at discharge (+9.7 +/- 16% in the training group; -1 +/- 13% in control subjects; P = 0.05) and at 1 month follow-up in the patients who trained. The 6-minute walking distance improved after discharge only in the group who received resistance training (median 34; interquartile range, 14-61 m; P = 0.002). In a subgroup of patients a muscle biopsy showed a more anabolic status of skeletal muscle in patients who followed training. Myostatin was lower (P = 0.03) and the myogenin/MyoD ratio tended to be higher (P = 0.08) in the training group compared with control subjects.
Resistance training is safe, successfully counteracts skeletal muscle dysfunction during acute exacerbations of COPD, and may up-regulate the anabolic milieu in the skeletal muscle. Clinical trial registered with www.clinicaltrials.gov (NCT00877084).
Quadriceps strength relates to exercise capacity and prognosis in chronic obstructive pulmonary disease (COPD). We wanted to quantify the prevalence of quadriceps weakness in COPD and hypothesised that it would not be restricted to patients with severe airflow obstruction or dyspnoea. Predicted quadriceps strength was calculated using a regression equation (incorporating age, sex, height and fat-free mass), based on measurements from 212 healthy subjects. The prevalence of weakness (defined as observed values 1.645 standardised residuals below predicted) was related to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage and Medical Research Council (MRC) dyspnoea score in two cohorts of stable COPD outpatients recruited from the UK (n = 240) and the Netherlands (n = 351). 32% and 33% of UK and Dutch COPD patients had quadriceps weakness. A significant proportion of patients in GOLD stages 1 and 2, or with an MRC dyspnoea score of 1 or 2, had quadriceps weakness (28 and 26%, respectively). These values rose to 38% in GOLD stage 4, and 43% in patients with an MRC Score of 4 or 5. Quadriceps weakness was demonstrable in one-third of COPD patients attending hospital respiratory outpatient services. Quadriceps weakness exists in the absence of severe airflow obstruction or breathlessness.
BACKGROUND PATIENTS: with chronic airflow obstruction are often limited by muscle fatigue and weakness. As exercise rehabilitation programmes have produced modest improvements at best a study was designed to determine whether specific muscle training techniques are helpful.
Thirty four patients with chronic airflow limitation (forced expiratory volume in one second (FEV1) 38% of predicted values) were stratified for FEV1 to vital capacity (VC) ratio less than 40% and arterial oxygen desaturation during exercise and randomised to a control or weightlifting training group. In the experimental group training was prescribed for upper and lower limb muscles as a percentage of the maximum weight that could be lifted once only. It was carried out three times a week for eight weeks.
Three subjects dropped out of each group; results in the remaining 14 patients in each group were analysed. Adherence in the training group was 90%. In the trained subjects muscle strength and endurance time during cycling at 80% of maximum power output increased by 73% from 518 (SE69) to 898 (95) s, with control subjects showing no change (506 (86) s before training and 479 (89) s after training). No significant changes in maximum cycle ergometer exercise capacity or distance walked in six minutes were found in either group. Responses to a chronic respiratory questionnaire showed significant improvements in dyspnoea and mastery of daily living activities in the trained group.
Weightlifting training may be successfully used in patients with chronic airflow limitation, with benefits in muscle strength, exercise endurance, and subjective responses to some of the demands of daily living.
When the intent is to quantify performance of lower extremity muscles, the sit-to-stand test is a practical alternative to manual muscle testing and various instrumented options. Several procedures for performing the test are presented in this review as is information relevant to test interpretation. Performance variables known to be associated with sit-to-stand performance are noted.
Measuring lower body strength is critical in evaluating the functional performance of older adults. The purpose of this study was to assess the test-retest reliability and the criterion-related and construct validity of a 30-s chair stand as a measure of lower body strength in adults over the age of 60 years. Seventy-six community-dwelling older adults (M age = 70.5 years) volunteered to participate in the study, which involved performing two 30-s chair-stand tests and two maximum leg-press tests, each conducted on separate days 2-5 days apart. Test-retest intraclass correlations of .84 for men and .92 for women, utilizing one-way analysis of variance procedures appropriate for a single trial, together with a nonsignificant change in scores from Day 1 testing to Day 2, indicate that the 30-s chair stand has good stability reliability. A moderately high correlation between chair-stand performance and maximum weight-adjusted leg-press performance for both men and women (r = .78 and .71, respectively) supports the criterion-related validity of the chair stand as a measure of lower body strength. Construct (or discriminant) validity of the chair stand was demonstrated by the test's ability to detect differences between various age and physical activity level groups. As expected, chair-stand performance decreased significantly across age groups in decades--from the 60s to the 70s to the 80s (p < .01) and was significantly lower for low-active participants than for high-active participants (p < .0001). It was concluded that the 30-s chair stand provides a reasonably reliable and valid indicator of lower body strength in generally active, community-dwelling older adults.
The effects of endurance training on exercise capacity and health-related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD) patients have been studied thoroughly, while resistance training has been rarely evaluated. This study investigated the effects of resistance training in comparison with endurance training in patients with moderate to severe COPD and peripheral muscle weakness (isometric knee extension peak torque <75% predicted). Forty-eight patients (age 64+/-8 yrs, forced expiratory volume in one second 38+/-17% pred) were randomly assigned to resistance training (RT, n=24) or endurance training (ET, n=24). The former consisted of dynamic strengthening exercises. The latter consisted of walking, cycling and arm cranking. Respiratory and peripheral muscle force, exercise capacity, and HRQL were re-evaluated in all patients who completed the 12-week rehabilitation (RT n=14, ET n=16). Statistically significant increases in knee extension peak torque (RT 20+/-21%, ET 42+/-21%), maximal knee flexion force (RT 31+/-39%, ET 28+/-37%), elbow flexion force (RT 24+/-19%, ET 33+/-25%), 6-min walking distance (6MWD) (RT 79+/-74 m, ET 95+/-57 m), maximum workload (RT 15+/-16 Watt, ET 14+/-13 Watt) and HRQL (RT 16+/-25 points, ET 16+/-15 points) were observed. No significant differences in changes in HRQL and 6MWD were seen between the two treatments. Resistance training and endurance training have similar effects on peripheral muscle force, exercise capacity and health-related quality of life in chronic obstructive pulmonary disease patients with peripheral muscle weakness.
Sit-to-stand (STS) performance is often used as a measure of lower-limb strength in older people and those with significant weakness. However, the findings of recent studies suggest that performance in this test is also influenced by factors associated with balance and mobility. We conducted a study to determine whether sensorimotor, balance, and psychological factors in addition to lower-limb strength predict sit-to-stand performance in older people.
Six hundred and sixty nine community-dwelling men and women aged 75-93 years (mean age 78.9, SD = 4.1) underwent quantitative tests of strength, vision, peripheral sensation, reaction time, balance, health status, and sit-to-stand performance.
Many physiological and psychological factors were significantly associated with sit-to-stand times in univariate analyses. Multiple regression analysis revealed that visual contrast sensitivity, lower limb proprioception, peripheral tactile sensitivity, reaction time involving a foot-press response, sway with eyes open on a foam rubber mat, body weight, and scores on the Short-Form 12 Health Status Questionnaire pain, anxiety, and vitality scales in addition to knee extension, knee flexion, and ankle dorsiflexion strength were significant and independent predictors of STS performance. Of these measures, quadriceps strength had the highest beta weight, indicating it was the most important variable in explaining the variance in STS times. However, the remaining measures accounted for more than half the explained variance in STS times. The final regression model explained 34.9% of the variance in STS times (multiple R =.59).
The findings indicate that, in community-dwelling older people, STS performance is influenced by multiple physiological and psychological processes and represents a particular transfer skill, rather than a proxy measure of lower limb strength.
This meta-analysis was conducted to generate normative values for the 5-repetition sit-to-stand (STS) test suitable for application to individuals at least 60 years of age. A thorough review of the literature yielded 13 papers (14 studies) relevant to this purpose. After the exclusion of potentially unrepresentative data, meta-analysis of these 13 papers indicated that judgments about normal performance should be based on age. Analysis demonstrated that individuals with times for 5 repetitions of this test exceeding the following can be considered to have worse than average performance: 11.4 sec (60 to 69 years), 12.6 sec. (70 to 79 years), and 14.8 sec. (80 to 89 years).
Cycle training intensity for patients with chronic obstructive pulmonary disease (COPD) is normally based on an incremental cycle test. Such tests are expensive and not readily available to clinicians. The six-minute walk test (6MWT) has been proposed as an alternative to an incremental cycle test for this purpose, based on the findings of previous research that the peak oxygen consumption (VO2peak) for the incremental cycle test and the 6MWT was equivalent in participants with COPD. A regression equation relating distance walked on the 6MWT and peak work rate (Wpeak) on the incremental cycle test has been described. The aim of this study is to measure the physiological responses to constant load cycle exercise performed at an intensity of 60% Wpeak determined from the 6MWT in participants with stable COPD.
This study is a prospective, repeated measures design. Thirty-five participants with stable COPD and mild to severe lung disease will be recruited from referrals to pulmonary rehabilitation. Subjects with co-morbidities limiting exercise performance will be excluded. Two 6MWTs will be performed. The better 6MWT will be used to calculate Wpeak for cycle exercise from a regression equation. After 30 minutes rest, subjects will perform ten minutes of constant-load cycle exercise at 60% of the calculated Wpeak. During all exercise, cardiorespiratory and metabolic data (Cosmed K4b2), dyspnoea and rate of perceived exertion (RPE) will be recorded. The VO2 measured at the end of cycle exercise will be compared to VO2peak of the 6MWT (VO2bike/VO2walk). Pearson's correlation coefficient will be calculated for the relationship between VO2bike and VO2walk. A one-way analysis of variance (ANOVA), with Bonferroni correction, will be performed to determine whether the ratio of VO2bike/VO2walk is affected by disease severity.
This novel study will measure the physiological responses to cycle exercise, in terms of VO2peak, performed at an intensity determined from the 6MWT in participants with COPD. Positive findings will enable clinicians to more precisely prescribe cycle training intensity by utilising a simple, reliable and inexpensive 6MWT, thus providing a better standard of care for patients with COPD referred to pulmonary rehabilitation.
ACTRNO12606000496516.
Introduction:
Chronic obstructive pulmonary disease (COPD) is frequently associated with a reduced functional exercise performance. Even if this parameter is routinely evaluated using 6-minute walking test (6MWT), new field tests are regularly investigated as alternative tests. The aim of this study was to compare functional exercise performance evaluation by sit-to-stand test (STST) and 6MWT and to evaluate reliability and repeatability of the STST in COPD patients.
Method:
Forty-two COPD patients performed randomly two tests: 6MWT and STST. Each test was repeated two times. Distance (6MWD) and number of repetitions were measured. Cardiorespiratory parameters, dyspnea and lower limb fatigue (Borg) were recorded before and after the tests.
Results:
Sit-to-stand repetitions (19 ± 6) and 6MWD (441 ± 104 m) were correlated (r = .716; P < .001). Good repeatability was found for STST and 6MWT. Good reliability was observed for STST (ICC = 0.902). Variations of heart rate and pulsed oxygen saturation were significantly different between these two tests (23% ± 17% vs 13% ± 11%; P = .022 and -7.6% ± 4.6% vs -0.7% ± 2.7%; P < .001 for 6MWT and STST, respectively). Variations of dyspnea and lower limb fatigue were similar between both tests (P = .827 and P = .467).
Conclusion:
The one minute sit-to-stand test is a valuable alternative to 6MWT to estimate functional exercise performance in COPD patients. The cardiorespiratory demand is different between both tests although the variation of dypsnea is similar. No learning effect was observed for STST.
Background
Sit-to-stand tests (STST) have recently been developed as easy-to-use field tests to evaluate exercise tolerance in COPD patients. As several modalities of the test exist, this review presents a synthesis of the advantages and limitations of these tools with the objective of helping health professionals to identify the STST modality most appropriate for their patients.
Method
Seventeen original articles dealing with STST in COPD patients have been identified and analysed including eleven on 1min-STST and four other versions of the test (ranging from 5 to 10 repetitions and from 30 s to 3 min). In these studies the results obtained in sit-to-stand tests and the recorded physiological variables have been correlated with the results reported in other functional tests.
Results
A good set of correlations was achieved between STST performances and the results reported in other functional tests, as well as quality of life scores and prognostic index. According to the different STST versions the processes involved in performance are different and consistent with more or less pronounced associations with various physical qualities. These tests are easy to use in a home environment, with excellent metrological properties and responsiveness to pulmonary rehabilitation, even though repetition of the same movement remains a fragmented and restrictive approach to overall physical evaluation.
Conclusions
The STST appears to be a relevant and valid tool to assess functional status in COPD patients. While all versions of STST have been tested in COPD patients, they should not be considered as equivalent or interchangeable.
Our aim was to comprehensively validate the 1-min sit-to-stand (STS) test in chronic obstructive pulmonary disease (COPD) patients and explore the physiological response to the test.
We used data from two longitudinal studies of COPD patients who completed inpatient pulmonary rehabilitation programmes. We collected 1-min STS test, 6-min walk test (6MWT), health-related quality of life, dyspnoea and exercise cardiorespiratory data at admission and discharge. We assessed the learning effect, test–retest reliability, construct validity, responsiveness and minimal important difference of the 1-min STS test.
In both studies (n=52 and n=203) the 1-min STS test was strongly correlated with the 6MWT at admission (r=0.59 and 0.64, respectively) and discharge (r=0.67 and 0.68, respectively). Intraclass correlation coefficients (95% CI) between 1-min STS tests were 0.93 (0.83–0.97) for learning effect and 0.99 (0.97–1.00) for reliability. Standardised response means (95% CI) were 0.87 (0.58–1.16) and 0.91 (0.78–1.07). The estimated minimal important difference was three repetitions. End-exercise oxygen consumption, carbon dioxide output, ventilation, breathing frequency and heart rate were similar in the 1-min STS test and 6MWT.
The 1-min STS test is a reliable, valid and responsive test for measuring functional exercise capacity in COPD patients and elicited a physiological response comparable to that of the 6MWT.
Objective
To provide reference values and reference equations for frequently used clinical field tests and a self-reported measure of health-related physical fitness for use in clinical practice.
Design
Cross sectional design.
Setting
The general community.
Participants
A convenient sample of 370 volunteers between 18 and 90 years of age were recruited from a wide range of settings (i.e. work sites, schools, community centers for the elderly) and different geographical locations (i.e. urban, suburban and rural places) with in southeastern Norway.
Interventions
Not applicable.
Main Outcome Measures
The participants conducted five clinical field tests (the 6 minute walk test, the stair test, the 30 second sit-to-stand test, the handgrip test and the fingertip-to-floor test).
Results
The results of the field tests showed that performance remained unchanged until approximately 50 years of age, after that the performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%) and seconds used on the stair test (59%) could be well predicted by age, gender, height and weight in participants ≥50 years of age, whereas the performance on all tests were less well predicted in participants <50 years of age.
Conclusion
The reference values and reference equations provided in this study may increase the applicability and interpretability of the 6 minute walk test, the stair test, the 30-second sit-to-stand test, the handgrip test, and the fingertip-to-floor test in clinical practice.
Background Moving from sitting to standing is a common activity of daily living. The five-repetition sit-to-stand test (5STS) is a test of lower limb function that measures the fastest time taken to stand five times from a chair with arms folded. The 5STS has been validated in healthy community-dwelling adults, but data in chronic obstructive pulmonary disease (COPD) populations are lacking.
Aims To determine the reliability, validity and responsiveness of the 5STS in patients with COPD.
Methods Test-retest and interobserver reliability of the 5STS was measured in 50 patients with COPD. To address construct validity we collected data on the 5STS, exercise capacity (incremental shuttle walk (ISW)), lower limb strength (quadriceps maximum voluntary contraction (QMVC)), health status (St George's Respiratory Questionnaire (SGRQ)) and composite mortality indices (Age Dyspnoea Obstruction index (ADO), BODE index (iBODE)). Responsiveness was determined by measuring 5STS before and after outpatient pulmonary rehabilitation (PR) in 239 patients. Minimum clinically important difference (MCID) was estimated using anchor-based methods.
Results Test-retest and interobserver intraclass correlation coefficients were 0.97 and 0.99, respectively. 5STS time correlated significantly with ISW, QMVC, SGRQ, ADO and iBODE (r=−0.59, −0.38, 0.35, 0.42 and 0.46, respectively; all p<0.001). Median (25th, 75th centiles) 5STS time decreased with PR (Pre: 14.1 (11.5, 21.3) vs Post: 12.4 (10.2, 16.3) s; p<0.001). Using different anchors, a conservative estimate for the MCID was 1.7 s.
Conclusions The 5STS is reliable, valid and responsive in patients with COPD with an estimated MCID of 1.7 s. It is a practical functional outcome measure suitable for use in most healthcare settings.
Functional loss (often quantified as exercise limitation) is common in patients with chronic lung disease. The factors involved are multiple and many may be present together in a given patient. Ventilatory factors involve an imbalance in load/capacity relationships. Specifically, breathing loads from abnormal respiratory-system mechanics and/or excessive ventilatory demand cannot be handled by respiratory muscles that are dysfunctional or malpositioned. Gas-exchange factors involve impaired ventilation-perfusion relationships that lead to hypoxemia, impaired oxygen delivery, and pulmonary hypertension. Cardiovascular factors involve coexisting intrinsic heart disease, right-ventricular overload from pulmonary vascular abnormalities, and simple deconditioning. Skeletal muscle (both respiratory and limb) factors involve direct inflammatory mediator effects on muscle function, malnutrition, blood-gas abnormalities, compromised oxygen delivery from right-heart dysfunction, electrolyte imbalances, drugs, and comorbid states. Other less well understood factors include excessive dyspnea, impaired motivation, orthopedic issues, and psychiatric issues.
A simple, rapid, reproducible method for quantification of lower extremity muscle strength was standardized. The time needed to stand 10 times from a standard chair was recorded in 139 healthy subjects, aged 20 to 85 years (77 men, 62 women). Reproducibility was 6.8 percent (+/- 3.4 percent). Neither height nor weight was related to time in either sex. Weight was related to time (p less than 0.05) after adjusting for age, but this effect was slight compared with the effect of age alone. A highly significant (p less than 0.0001) relationship between time and age was found in both sexes. Younger men performed better than younger women, although this difference was lost in the older age groups. The results of this simple test correlated well with published data on the strength of knee flexor and extensor muscles in groups of men and women of various ages. This method was used to evaluate serially six consecutive patients with classic polymyositis or dermatomyositis. Improvement after treatment with prednisone used alone or in combination with azathioprine or methotrexate was found in all cases.
The clinical performance of a laboratory test can be described in terms of diagnostic accuracy, or the ability to correctly classify subjects into clinically relevant subgroups. Diagnostic accuracy refers to the quality of the information provided by the classification device and should be distinguished from the usefulness, or actual practical value, of the information. Receiver-operating characteristic (ROC) plots provide a pure index of accuracy by demonstrating the limits of a test's ability to discriminate between alternative states of health over the complete spectrum of operating conditions. Furthermore, ROC plots occupy a central or unifying position in the process of assessing and using diagnostic tools. Once the plot is generated, a user can readily go on to many other activities such as performing quantitative ROC analysis and comparisons of tests, using likelihood ratio to revise the probability of disease in individual subjects, selecting decision thresholds, using logistic-regression analysis, using discriminant-function analysis, or incorporating the tool into a clinical strategy by using decision analysis.
In this article, the concept that muscle wasting in COPD is in fact a state of cachexia was developed. Muscle wasting should be considered as a serious complication in COPD and other chronic illnesses with important implications for survival. Up to now, there is no effective treatment for this complication but optimism is warranted now that the understanding of the molecular mechanisms of cachexia has evolved. Research on muscle wasting is extremely active and this will eventually lead to the development of specific treatments for cachexia such as proteasome and cytokine inhibition or muscle growth factors. The clinical approach to cachexia in COPD and other chronic diseases should change dramatically in the near future. This is an exciting research area to follow.
We determined the effect of different exercise training modalities in patients with chronic obstructive pulmonary disease, including strength training (n = 17), endurance training (n = 16), and combined strength and endurance (n = 14) (half of the endurance and half of the strengthening exercises). Data were compared at baseline, the end of the 12-week exercise-training program, and 12 weeks later. Improvement in the walking distance was only significant in the strength group. Increases in submaximal exercise capacity for the endurance group were significantly higher than those observed in the strength group but were of similar magnitude than those in the combined training modality, which in turn were significantly higher than for the strength group. Increases in the strength of the muscle groups measured in five weight lifting exercises were significantly higher in the strength group than in the endurance group but were of similar magnitude than in the combined training group, which again showed significantly higher increases than subjects in the endurance group. Any training modality showed significant improvements of the breathlessness score and the dyspnea dimension of the chronic respiratory questionnaire. In conclusion, the combination of strength and endurance training seems an adequate training strategy for chronic obstructive pulmonary disease patients.
Dyspnoea is a primary symptom of chronic obstructive pulmonary disease (COPD). The baseline (BDI) and transition (TDI) dyspnoea indices are commonly used instruments to assess breathlessness and the impact of intervention. Its validity and pattern of response in multinational clinical trials has not been established. In a retrospective analysis of a cohort of 997 COPD patients who received tiotropium, salmeterol or placebo, in addition to usual care, the validity and pattern of response of the BDI and TDI were examined. The BDI was significantly correlated with the dyspnoea diary (DD) score and the symptom and activity components of the St. George's respiratory questionnaire (SGRQ), establishing concurrent validity. Furthermore, the TDI was also correlated with the changes in DD, SGRQ symptom and activity scores. Construct validity was established by the association between baseline forced expiratory volume in one second (FEV1) and BDI and AFEVI with TDI. Physician's global evaluation (PGE) was significantly associated with BDI as well as APGE with TDI. Significant correlations have also been observed when the cohorts were classified according to native English and native non-English speaking countries. A change in PGE of 1 category (i.e. 2 units on an 8-point scale) was associated with a mean TDI of approximately 1 unit (0.9-1.3 mean focal score), lending further support to the clinical significance of this change inherent in the instrument's descriptors. TDI responders (i.e. focal score < or = 1 unit) used less supplemental salbutamol, had fewer exacerbations and had significantly improved health status as measured by impacts and total SGRQ scores compared with nonresponders. In conclusion, the transition dyspnoea index is a valid instrument when used in a multinational clinical trial and the patterns of response confirm a 1-unit change in the transition dyspnoea index focal score as being clinically important.
The aim of this study was to examine the reliability and validity of field tests for assessing physical function in mid-aged and young-old people (55-70 y). Tests were selected that required minimal space and equipment and could be implemented in multiple field settings such as a general practitioner's office. Nineteen participants completed 2 field and 1 laboratory testing sessions. Intra-class correlations showed good reliability for the tests of upper body strength (lift and reach, R= .66), lower body strength (sit to stand, R = .80) and functional capacity (Canadian Step Test, R= .92), but not for leg power (single timed chair rise. R = .28). There was also good reliability for the balance test during 3 stances: parallel (94.7% agreement), semi-tandem (73.7%), and tandem (52.6%). Comparison of field test results with objective laboratory measures found good validity for the sit to stand (cf 1RM leg press, Pearson r= .68, p < .05), and for the step test (cf PWC140, r = -.60, p < .001), but not for the lift and reach (cf 1RM bench press, r = .43, p > .05), balance (r = -.13, -.18, .23) and rate of force development tests (r = -.28). It was concluded that the lower body strength and cardiovascular function tests were appropriate for use in field settings with mid-aged and young-old adults.
To discuss the utility of Sit-to-Stand Test (STST) compared to the 6min walking test (6MWT) for the evaluation of functional status in patients with chronic obstructive pulmonary disease (COPD).
Fifty-three patients with stable COPD (mean forced expiratory volume in 1s (FEV(1)) 46+/-9% predicted, mean age 71+/-12 year) and 15 healthy individuals (mean FEV(1) 101+/-13% predicted and mean age 63+/-8) were included.
Functional performance was evaluated by STST and 6MWT. During the tests, severity of dyspnea (by Modified Borg Scale), heart rate, pulsed oxygen saturation (SpO(2), by Modified Borg Scale) (by pulse oxymeter), blood pressure were measured. The pulmonary function (by spirometry), quadriceps femoris muscle strength (by manual muscle test) and quality of life (by Nottingham Health Profile Survey) were evaluated.
The STST and 6MWT results were lower in COPD group than the healthy group (P<0.05). During the 6MWT the rise in the heart rate, systolic blood pressure and the decrease in SpO(2) were statistically significant according to STST in COPD groups (P<0.05). The STST and 6MWT were strongly correlated with each other in both groups (P<0.05). Similarly, they were correlated with age, quality of life, peripheral muscle strength and dyspnea severity in COPD groups (P<0.05).
Similar to 6MWT, STST is also able to determine the functional state correctly. Additionally, it produces less hemodynamical stress compared to the 6MWT. In conclusion, STST can be used as an alternative of the 6MWT in patients with COPD.
Interpreting changes in outcomes of clinical trials in chronic obstructive pulmonary disease should be viewed from a broader perspective than only the statistical significance of the findings. The minimal clinical difference in outcome measures provides a conceptual framework to assist in clinical trial interpretation and a methodology to assess the clinical relevance of study results. Use of distribution-based techniques, comparison with other external measures, and opinions from experts, clinicians and patients can assist in minimal clinically important difference development. Although the minimal clinically important difference has been suggested for a wide range of outcomes of importance in chronic obstructive pulmonary disease, many have not been subjected to rigorous analysis. For newer tools such as activity monitors and questionnaires and measures not widely employed such as laboratory-based exercise tests, minimal clinically important differences remain to be determined.
Skeletal muscle dysfunction in chronic obstructive pulmonary disease
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